Provider Demographics
NPI:1689106858
Name:LENABURG, DIRK L (DO, MBA)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:L
Last Name:LENABURG
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-9180
Mailing Address - Country:US
Mailing Address - Phone:918-809-7979
Mailing Address - Fax:
Practice Address - Street 1:1401 N 4TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1806
Practice Address - Country:US
Practice Address - Phone:405-527-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO5389207Q00000X
390200000X
OK7101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUO5389OtherFLORIDA DEPT OF HEALTH BOARD OF OSTEOPATHIC MEDICINE