Provider Demographics
NPI:1760581227
Name:W THOMAS OAKES JR, MD, PC
Entity Type:Organization
Organization Name:W THOMAS OAKES JR, MD, PC
Other - Org Name:TUPELO NEUROLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-844-7021
Mailing Address - Street 1:609 BRUNSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-844-7021
Mailing Address - Fax:662-842-5207
Practice Address - Street 1:609 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4948
Practice Address - Country:US
Practice Address - Phone:662-844-7021
Practice Address - Fax:662-842-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9012121Medicaid
MSC00327Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER