Provider Demographics
NPI:1679548572
Name:ELDRIDGE, TIMOTHY J (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:ELDRIDGE
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 1:401 SW 80TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8123
Mailing Address - Country:US
Mailing Address - Phone:405-286-9465
Mailing Address - Fax:405-286-9462
Practice Address - Street 1:608 NW 9TH ST STE 6200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1017
Practice Address - Country:US
Practice Address - Phone:405-232-4211
Practice Address - Fax:405-232-3767
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100041900AMedicaid
OK$$$$$$$$$002OtherBCBS
OKG36341Medicare UPIN
OK100041900AMedicaid