Provider Demographics
NPI:1467687319
Name:MORTEL, DAVID ISAAC TELAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ISAAC TELAN
Last Name:MORTEL
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 1:940 NE 13TH ST
Mailing Address - Street 2:SUITE 2G-2300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5008
Mailing Address - Country:US
Mailing Address - Phone:405-271-2429
Mailing Address - Fax:405-271-2421
Practice Address - Street 1:940 NE 14TH STREET, SUITE 2G-2300
Practice Address - Street 2:PEDIATRIC EMERGENCY MEDICINE OFFICE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-2429
Practice Address - Fax:405-271-2421
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003778208000000X
OK303902080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics