Provider Demographics
NPI:1326374059
Name:OLENBERGER, FRED LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:LEE
Last Name:OLENBERGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1514 W HALL OF FAME
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-0001
Mailing Address - Country:US
Mailing Address - Phone:405-744-7260
Mailing Address - Fax:405-744-7670
Practice Address - Street 1:1514 W HALL OF FAME
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-0001
Practice Address - Country:US
Practice Address - Phone:405-744-7260
Practice Address - Fax:405-744-7670
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant