MR. THADDEUS DWAYNE MITCHAM


Address: 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716
Phone: 4055826231

MR. THADDEUS DWAYNE MITCHAM (NPI# 1497120760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497120760
Entity Type Individual
Full Name MR. THADDEUS DWAYNE MITCHAM
Credential PHYSICIAN ASSISTANT
Practice Address 7050 Air Depot Blvd
Tinker Afb
OK 73145-8716
Practice Telephone 4055826231
Mailing Telephone 4055826231
Enumeration Date 2015-12-11
Last Update Date 2018-04-19
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 7050 AIR DEPOT BLVD
City TINKER AFB
State OK
Zip Code 73145-8716

Providers in the same location

NPI Name Taxonomy Address Enumeration
1902893084 Michelle Marie Wueste Pediatrics 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2005-10-04
1114486701 James Neal Dillard IIi Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2019-03-14
1407313125 Cindy Yie Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2019-02-28
1720501299 William Moore Student in an Organized Health Care Education/Training Program 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2017-07-17
1265954952 Mark Gosnell Jr. Military Health Care Provider 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2017-07-13
1245780170 Mary Phillips Social Worker 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2016-10-04
1528418175 David Rodriguez Family Medicine 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2016-06-14
1659755064 Benjamin Winston Dentist 7050 Air Depot Blvd, Sgdd, Tinker Afb, OK 73145-8716 2015-07-15
1063895068 Andrea Theye Psychologist 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2015-07-08
1598148850 Adrianna Harrell Social Worker 7050 Air Depot Blvd, Tinker Afb, OK 73145 2015-07-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1922630946 The Janz Corporation Durable Medical Equipment & Medical Supplies Tinker Afb Exchange, 3360 N. Avenue Bldg. 685, Tinker Afb, OK 73145 2020-02-07
1578863437 Stephanie Brushett Audiologist 8941 Entrance Road A, Bldg 3334, Rm 125, Tinker Afb, OK 73145 2010-10-26
1972530053 Mark Robert Bacon Physician Assistant 72nd Medical Group, 5700 Arnold St, Tinker Afb, OK 73145 2006-06-26
1417945346 Heather Renee' Ranger Kobel Psychologist 590 Mitchell Blvd, Tinker Afb, OK 73145 2005-10-13
1003332404 Davis Brigman Psychologist 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 2017-08-17
1801321393 Carolyne Bangurah Registered Nurse 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 2017-04-21
1558748491 Caitlin Clare Stevens General Practice 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 2015-04-29
1033498571 Sarah Katherine Turbush Dentist 72d Medical Group, Tinker Afb, OK 73145 2011-08-16
1508000282 Axelandra Tamar Sang Military Health Care Provider 5700 Arnold St, Bldg 5801, Tinker Afb, OK 73145 2009-04-27
1790936466 William David Hinojosa Surgery 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 2008-09-30
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1407366453 Luke Andrew Russell Physician Assistant 7050 Air Depot Blvd Bldg 1040, Tinker Afb, OK 73145-8716 2017-10-04
1568648681 Rebecca G Prim Physician Assistant 7050 Air Depot, Bldg 1094, Tinker Afb, OK 73145-8102 2008-01-18
1114486701 James Neal Dillard IIi Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2019-03-14
1407313125 Cindy Yie Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2019-02-28
1477942951 Jason Duren Physician Assistant 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145-8716 2015-01-21
1811322852 Joshua E Pearcy Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2013-09-10
1982923843 Joseph Jones Physician Assistant 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 2010-05-18
1982679130 Kristen Leigh Janssen Physician Assistant 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145-8716 2006-02-21

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1194326496 Courtland Henderson Physician Assistant 2614 Wagon Trl, Enid, OK 73703-1630 2020-11-03
1013517168 Madeleine Hill Physician Assistant 5304 N Hudson Ave, Oklahoma City, OK 73118-6232 2020-10-28
1851990097 Lauren Heim Physician Assistant 7324 Bucks Xing, Edmond, OK 73034-3520 2020-10-19
1003414673 Stephanie Ann Stephens Physician Assistant 5021 Eric Dr, Oklahoma City, OK 73135-4129 2020-10-15
1508464355 Lauren Danielle Ukleya Physician Assistant 1315 Chisholm Trail Pkwy Ste A, Duncan, OK 73533-1544 2020-10-14
1598362964 Madison Kitchens Physician Assistant 471688 Ok-51, Stilwell, OK 74960 2020-10-07
1689271041 Maissa Baker Mitwalli Physician Assistant 700 S Desert Palm Ave, Broken Arrow, OK 74012-8815 2020-10-07
1730705229 Jenna Specht Physician Assistant 2501 N 14th St, Ponca City, OK 74601-1734 2020-06-19
1477176147 April Dawn Sullivan Physician Assistant 1111 Walnut Dr, Ardmore, OK 73401-2354 2020-05-28
1497384754 Leah Cannady Hester Physician Assistant 3145 Midland Valley St, Norman, OK 73069-6970 2020-04-07
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Competitor

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City TINKER AFB
Zip Code 73145

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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