Provider Demographics
NPI:1295911568
Name:TERRY M. NAYFA DPM PC
Entity type:Organization
Organization Name:TERRY M. NAYFA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NAYFA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-947-5492
Mailing Address - Street 1:3612 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5642
Mailing Address - Country:US
Mailing Address - Phone:405-947-5492
Mailing Address - Fax:405-947-5532
Practice Address - Street 1:3612 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5642
Practice Address - Country:US
Practice Address - Phone:405-947-5492
Practice Address - Fax:405-947-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0845890002Medicare NSC