Provider Demographics
NPI:1518234343
Name:CLIFFORD D MCENTIRE, DPM, INC
Entity Type:Organization
Organization Name:CLIFFORD D MCENTIRE, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCENTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-235-7411
Mailing Address - Street 1:1700 EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-3021
Mailing Address - Country:US
Mailing Address - Phone:405-235-7411
Mailing Address - Fax:405-232-5705
Practice Address - Street 1:1700 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-3021
Practice Address - Country:US
Practice Address - Phone:405-235-7411
Practice Address - Fax:405-232-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty