Individual
MR. DAVID RALPH WYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4812 E 33RD ST, TULSA, OK 74135-2038
(918) 622-4126
(918) 270-2398
Mailing address
3922 S FLORENCE AVE, TULSA, OK 74105-3728
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1528
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100834750A
MEDICAID LEGACY
—
05
—
100834750A
—
OK
01
—
243631709
MEDICARE LEGACY
—
01
—
4581366
AETNA LEGACY
—
01
—
892690007003
BCBS LEGACY
—
Enumeration date
08/11/2006
Last updated
06/20/2012
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