Provider Demographics
NPI:1437148954
Name:UY, NATHAN WILSON I (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WILSON
Last Name:UY
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12697 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6236
Mailing Address - Country:US
Mailing Address - Phone:918-505-3200
Mailing Address - Fax:918-505-3225
Practice Address - Street 1:12697 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-6236
Practice Address - Country:US
Practice Address - Phone:918-505-3200
Practice Address - Fax:918-505-3225
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04310732085R0001X
OK242312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24231OtherMEDICAL LICENSURE
OK20004400AMedicaid
OK200750650AMedicaid
OK200750650AMedicaid
OKH93373Medicare UPIN