Provider Demographics
NPI:1316614894
Name:TAPEDO, WILLIE-ED CODY I
Entity type:Individual
Prefix:MR
First Name:WILLIE-ED
Middle Name:CODY
Last Name:TAPEDO
Suffix:I
Gender:M
Credentials:
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 729
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-0729
Mailing Address - Country:US
Mailing Address - Phone:405-247-2428
Mailing Address - Fax:
Practice Address - Street 1:423 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-2111
Practice Address - Country:US
Practice Address - Phone:405-247-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist