Provider Demographics
NPI:1871543330
Name:PEERY, THELMA LILLIE (DO)
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:LILLIE
Last Name:PEERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:L
Other - Last Name:ARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-3528
Mailing Address - Fax:918-744-3529
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-3528
Practice Address - Fax:918-744-3529
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3779207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100137430CMedicaid
OKH47469Medicare UPIN
OK249610206Medicare ID - Type Unspecified