Provider Demographics
NPI:1407840846
Name:MCINTYRE, DENNIS KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:KEITH
Last Name:MCINTYRE
Suffix:
Gender:M
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-242-3090
Mailing Address - Fax:
Practice Address - Street 1:721 W BROADWAY AVE STE D
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3800
Practice Address - Country:US
Practice Address - Phone:580-237-0322
Practice Address - Fax:580-233-0402
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100500DMedicaid
OKD35024Medicare UPIN
OK100100500DMedicaid