Provider Demographics
NPI:1205144177
Name:TONYA WASHBURN, M.D., P.C.
Entity type:Organization
Organization Name:TONYA WASHBURN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-650-6306
Mailing Address - Street 1:721 NW 6TH ST
Mailing Address - Street 2:201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1205
Mailing Address - Country:US
Mailing Address - Phone:405-235-5135
Mailing Address - Fax:405-235-5137
Practice Address - Street 1:721 NW 6TH ST
Practice Address - Street 2:201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1205
Practice Address - Country:US
Practice Address - Phone:405-235-5135
Practice Address - Fax:405-235-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18124208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty