Provider Demographics
NPI:1225170814
Name:OKERSON, THEODORE E II (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:E
Last Name:OKERSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:E
Other - Last Name:OKERSON
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 AMGEN CENTER DR
Mailing Address - Street 2:MS 38/3B
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1730
Mailing Address - Country:US
Mailing Address - Phone:805-447-9105
Mailing Address - Fax:
Practice Address - Street 1:1 AMGEN CENTER DR
Practice Address - Street 2:MS 38/3B
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1730
Practice Address - Country:US
Practice Address - Phone:805-447-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC472XMedicare PIN
CAA93186Medicare UPIN