Individual
TIMOTHY L GRODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13313 N MERIDIAN AVE, BUILDING D, OKLAHOMA CITY, OK 73120-8380
(405) 755-4290
(405) 755-7773
Mailing address
4401 W MEMORIAL RD, SUITE 140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
12230
OK
207RP1001X
Pulmonary Disease Physician
Primary
12230
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100187150B
—
OK
01
—
P00196981
RAILROAD MEDICARE
OK
Enumeration date
09/12/2005
Last updated
11/17/2014
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