Provider Demographics
NPI:1639287378
Name:BIRDWELL, DARYL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:E
Last Name:BIRDWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4417 W GORE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5978
Mailing Address - Country:US
Mailing Address - Phone:580-248-7417
Mailing Address - Fax:580-248-4847
Practice Address - Street 1:4417 W GORE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5978
Practice Address - Country:US
Practice Address - Phone:580-248-7417
Practice Address - Fax:580-248-4847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
OK10548OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10548OKOtherSTATE LIC
OKBB0862272OtherDEA
OKD38637Medicare UPIN