Individual
TYLER F WINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 S SAINT LOUIS AVE, TULSA, OK 74120-5440
(918) 619-4400
(918) 619-4662
Mailing address
PO BOX 268838, OKLAHOMA CITY, OK 73126-8838
(918) 619-4639
(918) 619-4662
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
39694
OK
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
39694
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201199720A
—
OK
Enumeration date
04/30/2019
Last updated
11/19/2024
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