Provider Demographics
NPI:1972770386
Name:PREVO, PATRICK TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:PREVO
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 1:800 NW 9TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7253
Mailing Address - Country:US
Mailing Address - Phone:405-231-2900
Mailing Address - Fax:405-272-4905
Practice Address - Street 1:800 NW 9TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7253
Practice Address - Country:US
Practice Address - Phone:405-231-2900
Practice Address - Fax:405-272-4905
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8261207Q00000X
OK29457208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine