Provider Demographics
NPI:1073146304
Name:ROY W BANKHEAD MD PC
Entity Type:Organization
Organization Name:ROY W BANKHEAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BANKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-474-1479
Mailing Address - Street 1:5700 N PORTLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1662
Mailing Address - Country:US
Mailing Address - Phone:405-843-5855
Mailing Address - Fax:405-843-5865
Practice Address - Street 1:5700 N PORTLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1662
Practice Address - Country:US
Practice Address - Phone:405-458-7162
Practice Address - Fax:405-384-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty