Provider Demographics
NPI:1467568097
Name:DANLEY, TABITHA D (DO)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:D
Last Name:DANLEY
Suffix:
Gender:F
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:PO BOX 269064
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9064
Mailing Address - Country:US
Mailing Address - Phone:405-272-5555
Mailing Address - Fax:405-272-5517
Practice Address - Street 1:6201 N SANTA FE AVE
Practice Address - Street 2:SUITE 2010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7538
Practice Address - Country:US
Practice Address - Phone:405-272-5555
Practice Address - Fax:405-272-5517
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8408536Medicaid
WAI19079Medicare UPIN
WA8857720Medicare ID - Type Unspecified