Provider Demographics
NPI:1255322699
Name:PARDUE, VICTORIA ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:PARDUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ELAINE
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1201 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4229
Mailing Address - Country:US
Mailing Address - Phone:580-326-6423
Mailing Address - Fax:580-326-3660
Practice Address - Street 1:1201 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-326-3660
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2840207Q00000X
FLOS5808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096850AMedicaid
OK100096850AMedicaid