Provider Demographics
NPI:1437125218
Name:TICHENOR, GREGORY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANDREW
Last Name:TICHENOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:TICHENOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P O BOX 960046
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:
Practice Address - Street 1:1600 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-848-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9391207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX930047705OtherRAILROAD MCARE THRU HEB
TX132071503Medicaid
TX85V309OtherBCBS THRU HEB
TNF39040Medicare UPIN
TX930047705OtherRAILROAD MCARE THRU HEB