Basic Information
| Provider Information | |||||||||
| NPI: | 1376570887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAY | ||||||||
| FirstName: | TIM | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 350 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186830753 | ||||||||
| FaxNumber: | 9186835677 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186830753 | ||||||||
| FaxNumber: | 9186835677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 11/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H7620 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 122106106 | 05 | TX | MEDICAID | 122106105 | 05 | TX | MEDICAID |