Individual
IWAN T TJAUW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3433 NW 54TH ST, SUITE C-40, OKLAHOMA CITY, OK 73112-4455
(405) 945-4741
(888) 972-5320
Mailing address
3433 NW 54TH ST, SUITE C-40, OKLAHOMA CITY, OK 73112-4455
(405) 945-4741
(888) 972-5320
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
24754
OK
2085N0700X
Neuroradiology Physician
Primary
24754
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100738500A
—
OK
01
—
P00283018
RAILROAD MEDICARE
OK
01
—
P00285866
RAILROAD MEDICARE/MPI
OK
01
—
P00302394
RAILROAD MEDICARE/AI
OK
Enumeration date
02/21/2006
Last updated
07/15/2021
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