Provider Demographics
NPI:1235219882
Name:TESKE, TIMOTHY WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:TESKE
Suffix:
Gender:
Credentials:DO
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 1484
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-1484
Mailing Address - Country:US
Mailing Address - Phone:580-233-6707
Mailing Address - Fax:580-233-3724
Practice Address - Street 1:900 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5410
Practice Address - Country:US
Practice Address - Phone:580-233-6707
Practice Address - Fax:580-233-3724
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100102540AMedicaid