Provider Demographics
NPI:1376746925
Name:BAYLOR, DUSTIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEE
Last Name:BAYLOR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-977-1834
Mailing Address - Fax:580-977-1806
Practice Address - Street 1:2821 N VAN BUREN
Practice Address - Street 2:SUITE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7273
Practice Address - Country:US
Practice Address - Phone:580-977-1834
Practice Address - Fax:580-977-1806
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-02-08
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Provider Licenses
StateLicense IDTaxonomies
OK24652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194480AMedicaid