Provider Demographics
NPI:1376509828
Name:DUNKLEBERGER, LLOYD SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:SCOTT
Last Name:DUNKLEBERGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 BROADWAY EXT STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6304
Mailing Address - Country:US
Mailing Address - Phone:405-424-5426
Mailing Address - Fax:405-424-5431
Practice Address - Street 1:9800 BROADWAY EXT STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-424-5426
Practice Address - Fax:405-424-5431
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200009050AMedicaid
OK200009050AMedicaid
S83199Medicare UPIN