MEDICARE: TIMOTHY J ELDRIDGE MD

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
1	208600000X	Surgery Physician	21880	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1679548572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY J ELDRIDGE MD

Provider Business Mailing Address
First Line	:	401 SW 80TH ST STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-8123
Country	:	US
Telephone Number	:	405-286-9465
Fax Number	:	405-286-9462

Provider Business Practice Location Address
First Line	:	608 NW 9TH ST STE 6200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1017
Country	:	US
Telephone Number	:	405-232-4211
Fax Number	:	405-232-3767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/26/2022

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