Provider Demographics
NPI:1881629079
Name:DENMARK, THOMAS KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENT
Last Name:DENMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T.
Other - Middle Name:KENT
Other - Last Name:DENMARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:54701 FILE NUMBER
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:909-558-3111
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST STE 1500
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4315
Practice Address - Country:US
Practice Address - Phone:918-592-9020
Practice Address - Fax:918-779-0219
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31977207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554250Medicaid
G65582Medicare UPIN
CA00A554250Medicaid