Provider Demographics
NPI:1790880219
Name:HOWARD, DEREK G (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:G
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0518
Mailing Address - Country:US
Mailing Address - Phone:479-452-9416
Mailing Address - Fax:479-452-9416
Practice Address - Street 1:1023 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1810
Practice Address - Country:US
Practice Address - Phone:580-223-7844
Practice Address - Fax:580-223-6285
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK34662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100153330AMedicaid
OK100153330AMedicaid