Provider Demographics
NPI:1609856350
Name:NUNN, THOMAS VAN (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VAN
Last Name:NUNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-459-8824
Mailing Address - Fax:918-307-2239
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-459-8824
Practice Address - Fax:918-307-2239
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2198207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124050AMedicaid
OKOKAAA3939Medicare PIN
OKC94604Medicare UPIN