Provider Demographics
NPI:1295808749
Name:WINDHAM, DEANNA C (DO)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:C
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1797
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-1797
Mailing Address - Country:US
Mailing Address - Phone:405-689-9669
Mailing Address - Fax:909-752-5458
Practice Address - Street 1:3030 NW EXPRESSWAY STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5466
Practice Address - Country:US
Practice Address - Phone:405-689-9669
Practice Address - Fax:909-752-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH93002Medicare UPIN