Individual
MICKEY R TYRRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
803 N FOREMAN ST, SUITE 102, VINITA, OK 74301-1412
(918) 256-2261
(918) 256-2304
Mailing address
803 N FOREMAN ST, SUITE 102, VINITA, OK 74301-1412
(918) 256-2261
(918) 256-2304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22897
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200056320B
—
OK
Enumeration date
06/03/2006
Last updated
03/22/2011
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