Provider Demographics
NPI:1598907115
Name:CRITTENDEN, NEIL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:EDWARD
Last Name:CRITTENDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4462
Mailing Address - Country:US
Mailing Address - Phone:405-702-1300
Mailing Address - Fax:405-702-1280
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4462
Practice Address - Country:US
Practice Address - Phone:405-702-1300
Practice Address - Fax:405-702-1280
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY44978207R00000X
OK32073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100132650Medicaid
OK200634860AMedicaid