Provider Demographics
NPI:1891716775
Name:STUART, DANNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNA
Middle Name:K
Last Name:STUART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANNA
Other - Middle Name:K
Other - Last Name:DERSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858-0827
Mailing Address - Country:US
Mailing Address - Phone:580-938-5400
Mailing Address - Fax:580-938-5409
Practice Address - Street 1:404 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858
Practice Address - Country:US
Practice Address - Phone:580-938-5400
Practice Address - Fax:580-938-5409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200093290AMedicaid
OKI35530Medicare UPIN
OK24M731619Medicare PIN