Basic Information
| Provider Information | |||||||||
| NPI: | 1104054469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANDY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4502 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741359923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186603416 | ||||||||
| FaxNumber: | 9186603426 | ||||||||
| Practice Location | |||||||||
| Address1: | 4502 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741359923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186603416 | ||||||||
| FaxNumber: | 9186603426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 06/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 27250 | OK | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.