Provider Demographics
NPI:1467410357
Name:DIEHL, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DIEHL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-636-7650
Mailing Address - Fax:405-636-7743
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 3030
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-7650
Practice Address - Fax:405-636-7743
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2017-07-19
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Provider Licenses
StateLicense IDTaxonomies
OK12883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059480AMedicaid
OK200059480AMedicaid
OKD38748Medicare UPIN