Provider Demographics
NPI:1235420043
Name:KIRKPATRICK, TY DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:DOUGLAS
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E 19TH ST STE 800
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5464
Mailing Address - Country:US
Mailing Address - Phone:918-301-2505
Mailing Address - Fax:918-744-3633
Practice Address - Street 1:1725 E 19TH ST STE 800
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5464
Practice Address - Country:US
Practice Address - Phone:918-301-2505
Practice Address - Fax:918-744-3633
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5243208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program