Provider Demographics
NPI:1013968619
Name:COMBS, DAVID LYLE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LYLE
Last Name:COMBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:STE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-392-4477
Mailing Address - Fax:918-392-4465
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-392-5500
Practice Address - Fax:918-392-5512
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK17660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255760CMedicaid
OK800522535OtherMEDICARE GROUP PIN
OK246712306Medicare PIN
OK100255760CMedicaid