Basic Information
| Provider Information | |||||||||
| NPI: | 1407288756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILIPSON | ||||||||
| FirstName: | TYRONE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 N MONTE VISTA ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804211127 | ||||||||
| FaxNumber: | 5804366674 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 N MONTE VISTA ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804211127 | ||||||||
| FaxNumber: | 5804366674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2013 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 137903 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 31793 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.