Provider Demographics
NPI:1790833416
Name:TAHLEQUAH MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:TAHLEQUAH MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-456-0592
Mailing Address - Street 1:1500 E DOWNING ST STE 205
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3379
Mailing Address - Country:US
Mailing Address - Phone:918-456-0592
Mailing Address - Fax:918-456-0252
Practice Address - Street 1:1500 E DOWNING ST STE 205
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3379
Practice Address - Country:US
Practice Address - Phone:918-456-0592
Practice Address - Fax:918-456-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty