Provider Demographics
NPI:1477695864
Name:SPEEGLE, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SPEEGLE
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 1:1701 RENAISSANCE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3084
Mailing Address - Country:US
Mailing Address - Phone:405-844-4978
Mailing Address - Fax:405-844-0562
Practice Address - Street 1:1705 RENAISSANCE BLVD
Practice Address - Street 2:STE 120
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3043
Practice Address - Country:US
Practice Address - Phone:405-844-8572
Practice Address - Fax:405-844-9143
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200177880AMedicaid
OKOK404028Medicare PIN
OK200177880AMedicaid