Provider Demographics
NPI:1578539029
Name:THOMAS, RUPERT ROCKWELL SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:ROCKWELL
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 960551
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-2006
Mailing Address - Country:US
Mailing Address - Phone:405-418-4800
Mailing Address - Fax:405-418-4820
Practice Address - Street 1:1616 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3651
Practice Address - Country:US
Practice Address - Phone:405-736-0089
Practice Address - Fax:405-216-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12932261QP2300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100005830AMedicaid