Individual
MICHAEL A THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5501 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-2074
(405) 604-6000
(918) 664-2521
Mailing address
4500 S GARNETT RD, SUITE 300, TULSA, OK 74146-5229
(918) 664-9892
(918) 664-2521
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1064
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090360A
—
OK
Enumeration date
05/24/2005
Last updated
12/09/2009
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