Provider Demographics
NPI:1134197205
Name:PYLES, TRACY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:PYLES
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 1:1030 E CHERRY
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4102
Mailing Address - Country:US
Mailing Address - Phone:918-225-0616
Mailing Address - Fax:918-225-3740
Practice Address - Street 1:1030 E CHERRY
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4102
Practice Address - Country:US
Practice Address - Phone:918-225-0616
Practice Address - Fax:918-225-3740
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100161100AMedicaid
OKOKA103117Medicare PIN
OK100161100AMedicaid