Provider Demographics
NPI:1003809583
Name:NAYFA, TERRY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:NAYFA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5642
Mailing Address - Country:US
Mailing Address - Phone:405-947-5492
Mailing Address - Fax:405-947-5532
Practice Address - Street 1:3612 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5642
Practice Address - Country:US
Practice Address - Phone:405-947-5492
Practice Address - Fax:405-947-5532
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0845890002Medicare NSC
T40770Medicare UPIN
OK0845890001Medicare NSC