Individual
DR. TYSON RICHARD TRIMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
900 E 13TH ST, SUITE 104, GROVE, OK 74344-2975
(918) 786-3391
(918) 786-7264
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(918) 786-3391
(918) 786-7264
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4694
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200216420B
—
OK
05
—
200462050O
—
OK
Enumeration date
07/15/2008
Last updated
04/05/2017
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