Provider Demographics
NPI:1811954241
Name:MARLOW, TIMOTHY K (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:K
Last Name:MARLOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 22063
Mailing Address - Street 2:DEPT 0289
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-2063
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:2929 S GARNETT RD
Practice Address - Street 2:C/O MEDCENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5101
Practice Address - Country:US
Practice Address - Phone:918-665-1520
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100118850AMedicaid
OK24H620530Medicare PIN
OK100118850AMedicaid
OKP30752Medicare UPIN
OKPA008921Medicare PIN
OK24H619024Medicare PIN
OK249401504Medicare PIN