Provider Demographics
NPI:1780853358
Name:SHOWALTER, THOMAS AMMEN III (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AMMEN
Last Name:SHOWALTER
Suffix:III
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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-773-6400
Mailing Address - Fax:405-621-5441
Practice Address - Street 1:5915 W MEMORIAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2021
Practice Address - Country:US
Practice Address - Phone:405-773-6400
Practice Address - Fax:405-621-5441
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine