Provider Demographics
NPI:1306955018
Name:MACLIN, TIMOTHY BURTON (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BURTON
Last Name:MACLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21568
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1568
Mailing Address - Country:US
Mailing Address - Phone:918-749-3228
Mailing Address - Fax:918-747-2759
Practice Address - Street 1:9318 S TOLEDO CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2746
Practice Address - Country:US
Practice Address - Phone:918-749-3228
Practice Address - Fax:918-747-2759
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK165213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0657650001OtherDMERC
OK731308674003OtherCIGNA
OK480005859Medicare PIN
OK0657650001OtherDMERC
OK$$$$$$$$$Medicare PIN