Provider Demographics
NPI:1831533421
Name:CHARLES D. VAN TUYL, PH.D., M.D.
Entity type:Organization
Organization Name:CHARLES D. VAN TUYL, PH.D., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:VANTUYL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:918-492-6333
Mailing Address - Street 1:6966 SOUTH UTICA
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:918-492-6333
Mailing Address - Fax:918-493-9405
Practice Address - Street 1:201 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1805
Practice Address - Country:US
Practice Address - Phone:918-492-6333
Practice Address - Fax:918-493-9405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES D. VAN TUYL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-25
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK165352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty