Provider Demographics
NPI:1366616526
Name:WILLIAM E TANKERSLEY MD PLLC
Entity type:Organization
Organization Name:WILLIAM E TANKERSLEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:TANKERSLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:405-799-0900
Mailing Address - Street 1:PO BOX 7411
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-1411
Mailing Address - Country:US
Mailing Address - Phone:405-799-0900
Mailing Address - Fax:405-799-0902
Practice Address - Street 1:604 S CLASSEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5401
Practice Address - Country:US
Practice Address - Phone:405-799-0900
Practice Address - Fax:405-799-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK240162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty