Provider Demographics
NPI:1548378375
Name:KOEHLER, TAMMIE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNN
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 2ND AVE SW
Mailing Address - Street 2:STE 204
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6743
Mailing Address - Country:US
Mailing Address - Phone:918-542-4300
Mailing Address - Fax:918-542-3310
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:STE 204
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6743
Practice Address - Country:US
Practice Address - Phone:918-542-4300
Practice Address - Fax:918-542-3310
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK03963207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200045440AMedicaid
OK200045440AMedicaid
OK248523507Medicare PIN