Individual
PAMELA HODGES TIETZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 NE 10TH ST, OKLAHOMA CITY, OK 73104-5420
(405) 271-4311
(405) 271-2797
Mailing address
900 NE 10TH ST, OKLAHOMA CITY, OK 73104-5420
(405) 271-4311
(405) 271-2797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18715
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100148940B
—
OK
01
—
800522535
MEDICARE GROUP PIN
OK
Enumeration date
02/16/2006
Last updated
12/12/2008
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