Provider Demographics
NPI:1417930793
Name:LIND, TIMOTHY A (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:A
Last Name:LIND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4939
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-0939
Mailing Address - Country:US
Mailing Address - Phone:918-743-8943
Mailing Address - Fax:918-388-1242
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:STE 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-743-8943
Practice Address - Fax:918-388-1242
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE28994Medicare UPIN
OKTULSR110Medicare ID - Type Unspecified