Provider Demographics
NPI:1851307607
Name:TAACA, PERRY THOMS (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:THOMS
Last Name:TAACA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1578
Mailing Address - Country:US
Mailing Address - Phone:405-557-1200
Mailing Address - Fax:405-557-1977
Practice Address - Street 1:4334 NW EXPRESSWAY
Practice Address - Street 2:SUITE 175
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1578
Practice Address - Country:US
Practice Address - Phone:405-557-1200
Practice Address - Fax:405-557-1977
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100099390BMedicaid
OK100099390BMedicaid