Provider Demographics
NPI:1790535409
Name:DARREN ELENBURG DPM PC
Entity Type:Organization
Organization Name:DARREN ELENBURG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-227-9440
Mailing Address - Street 1:609 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2006
Mailing Address - Country:US
Mailing Address - Phone:405-418-2676
Mailing Address - Fax:405-418-2677
Practice Address - Street 1:1703 PROFESSIONAL CIR STE 101
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6497
Practice Address - Country:US
Practice Address - Phone:405-418-2676
Practice Address - Fax:405-418-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty