Provider Demographics
NPI:1053402347
Name:TANKERSLEY, WILLIAM EARL IV (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARL
Last Name:TANKERSLEY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:EARL
Other - Last Name:TANKERSLEY
Other - Suffix:IV
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 7411
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-1411
Mailing Address - Country:US
Mailing Address - Phone:405-799-0900
Mailing Address - Fax:405-799-0902
Practice Address - Street 1:604 S CLASSEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5401
Practice Address - Country:US
Practice Address - Phone:405-799-0900
Practice Address - Fax:405-799-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK240162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry