Provider Demographics
NPI:1689655276
Name:CONKLIN, THOMAS HAROLD JR (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HAROLD
Last Name:CONKLIN
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0609
Mailing Address - Country:US
Mailing Address - Phone:918-967-2130
Mailing Address - Fax:918-967-2461
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2325
Practice Address - Country:US
Practice Address - Phone:918-967-2130
Practice Address - Fax:918-967-2461
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-14
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Provider Licenses
StateLicense IDTaxonomies
OK1552207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE45364Medicare UPIN