Provider Demographics
NPI:1790964146
Name:AMY LIBEL DARTER MD PC
Entity Type:Organization
Organization Name:AMY LIBEL DARTER MD PC
Other - Org Name:OKLAHOMA INSTITUTE OF ALLERGY & ASTHMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-607-4333
Mailing Address - Street 1:1810 E MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1250
Mailing Address - Country:US
Mailing Address - Phone:405-607-4333
Mailing Address - Fax:405-607-4404
Practice Address - Street 1:1810 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1250
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20754207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG83690Medicare UPIN
OK800522387Medicare PIN