1710417092 NPI number — PRASHANTH S IYER MD

Table of content: PRASHANTH S IYER MD (NPI 1710417092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710417092 NPI number — PRASHANTH S IYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IYER
Provider First Name:
PRASHANTH
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710417092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1265 S UTICA AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74104-4243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-592-0999
Provider Business Mailing Address Fax Number:
918-592-1021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 S WHEELING AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-749-6400
Provider Business Practice Location Address Fax Number:
918-749-2168
Provider Enumeration Date:
06/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  39831 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201100560A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com