Individual
TIMOTHY W. MEDCALF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 N MONTE VISTA ST, ADA, OK 74820-4607
(580) 364-5111
(580) 279-1994
Mailing address
527 W 3RD ST, KONAWA, OK 74849-1415
(580) 925-3286
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0431221
KS
207RC0000X
Cardiovascular Disease Physician
Primary
16129
OK
207RC0000X
Cardiovascular Disease Physician
2004020021
MO
207RC0000X
Cardiovascular Disease Physician
E-1653
AZ
207RC0000X
Cardiovascular Disease Physician
K4954
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100125290B
—
OK
01
—
200080110A
MEDICAID GROUP
OK
01
—
300522226
MEDICARE GROUP
OK
Enumeration date
03/30/2006
Last updated
11/18/2021
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