Provider Demographics
NPI:1902804248
Name:TIPSWORD, HEATHER ROSS (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ROSS
Last Name:TIPSWORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2514 NORTH MERIDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1035
Mailing Address - Country:US
Mailing Address - Phone:405-722-1110
Mailing Address - Fax:405-721-8263
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:954-399-4621
Practice Address - Fax:877-892-9770
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100114030AMedicaid
OKH80743Medicare UPIN
OK242421800AMedicare PIN