Organization
TRACEY W. CHILDERS, D.O. P.C.
Active
Other names
Childers Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY W CHILDERS DO (MEDICAL DIRECTOR)
(918) 453-1234
Entity
Organization
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4188
(918) 453-1234
(918) 453-9107
Mailing address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
3296
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200000030A
—
OK
Enumeration date
09/24/2007
Last updated
09/15/2010
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