Provider Demographics
NPI:1922099860
Name:ROWLAND, TEDDY RAY (MD)
Entity Type:Individual
Prefix:
First Name:TEDDY
Middle Name:RAY
Last Name:ROWLAND
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 1:603 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2636
Mailing Address - Country:US
Mailing Address - Phone:580-298-3351
Mailing Address - Fax:580-298-6137
Practice Address - Street 1:1201 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-326-3660
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK14790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100257110DMedicaid
OK100257110DMedicaid