Provider Demographics
NPI:1639157084
Name:MOREMAN, DENA (MD)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MOREMAN
Suffix:
Gender:F
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:PO BOX 58145
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-8145
Mailing Address - Country:US
Mailing Address - Phone:405-570-1188
Mailing Address - Fax:405-265-3337
Practice Address - Street 1:3600 WIMBERLY DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0401
Practice Address - Country:US
Practice Address - Phone:405-570-1188
Practice Address - Fax:405-265-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00117657OtherRR MEDICARE
OK100101730BMedicaid
G52684Medicare UPIN
OK100101730BMedicaid