Provider Demographics
NPI:1962601005
Name:DAVIS, THOMAS WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:W
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2129 SW 59TH ST
Mailing Address - Street 2:SUITE 1238
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-7024
Mailing Address - Country:US
Mailing Address - Phone:405-713-5779
Mailing Address - Fax:404-681-8085
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:SUITE 1238
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-5779
Practice Address - Fax:404-681-8085
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10683207RA0401X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine