Provider Demographics
NPI:1417006388
Name:SONG, CLARA (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:SONG
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 1:1200 EVERETT DR
Mailing Address - Street 2:7TH FLOOR NORTH PAVILION
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5215
Mailing Address - Fax:405-271-1236
Practice Address - Street 1:1200 EVERETT DR
Practice Address - Street 2:7TH FLOOR NORTH PAVILION
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5215
Practice Address - Fax:405-271-1236
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73456208000000X
OK27986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73456OtherMEDICAL LICENSE
CABS7402263OtherDEA LICENSE