Provider Demographics
NPI:1316906621
Name:THAYER, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:THAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2010
Mailing Address - Country:US
Mailing Address - Phone:405-470-7100
Mailing Address - Fax:405-470-7111
Practice Address - Street 1:5720 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2010
Practice Address - Country:US
Practice Address - Phone:405-470-7100
Practice Address - Fax:405-470-7111
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100088120AMedicaid
OK248514604Medicare ID - Type Unspecified
OK100088120AMedicaid