Provider Demographics
NPI:1962487124
Name:OELKE, DAVID EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:OELKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4521
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4521
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110094010OtherRR MEDICARE GROUP NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR110094010OtherRR MEDICARE PTAN NUMBER
OR142133Medicaid
OR1407812365OtherNBMC GROUP NPI NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR111969Medicare PIN
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR110094010OtherRR MEDICARE GROUP NUMBER