Provider Demographics
NPI:1336109750
Name:DARTER, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:DARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1250
Mailing Address - Country:US
Mailing Address - Phone:405-607-4333
Mailing Address - Fax:405-607-4404
Practice Address - Street 1:1810 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1250
Practice Address - Country:US
Practice Address - Phone:405-607-4333
Practice Address - Fax:405-607-4404
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20754207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1790964146OtherGROUP NPI
OKG83690Medicare UPIN
OK248430304Medicare ID - Type Unspecified
OK800522387Medicare ID - Type UnspecifiedGROUP NUMBER