Provider Demographics
NPI:1013901461
Name:WASHBURN, DANIEL DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DEAN
Last Name:WASHBURN
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-242-3090
Mailing Address - Fax:
Practice Address - Street 1:615 E OKLAHOMA AVE STE 208
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5952
Practice Address - Country:US
Practice Address - Phone:580-242-3090
Practice Address - Fax:580-234-2090
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11337207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01284450OtherRR MEDICARE
OK100253320DMedicaid
OK288078YPW9Medicare PIN
OKD35385Medicare UPIN