Basic Information
| Provider Information | |||||||||
| NPI: | 1205144177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TONYA WASHBURN, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 NW 6TH ST | ||||||||
| Address2: | 201 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052355135 | ||||||||
| FaxNumber: | 4052355137 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 NW 6TH ST | ||||||||
| Address2: | 201 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052355135 | ||||||||
| FaxNumber: | 4052355137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 09/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | WASHBURN | ||||||||
| AuthorizedOfficialFirstName: | TONYA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4056506306 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 18124 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.