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NPI Code Detail

MEDICARE: MICHAEL A THAYER PA

MEDICARE:   MICHAEL A THAYER  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1064OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558364422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL A THAYER PA
Provider Business Mailing Address
First Line : 4500 S GARNETT RD
Second Line : SUITE 300
City : TULSA
State : OK
Zip : 74146-5229
Country : US
Telephone Number : 918-664-9892
Fax Number : 918-664-2521
Provider Business Practice Location Address
First Line : 5501 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-2074
Country : US
Telephone Number : 405-604-6000
Fax Number : 918-664-2521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 12/09/2009

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Directions to “ MICHAEL A THAYER PA” Practice Location

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