Provider Demographics
NPI:1457431082
Name:FIKE, EDGAR ALLEN IV (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ALLEN
Last Name:FIKE
Suffix:IV
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:580-249-3468
Mailing Address - Fax:
Practice Address - Street 1:330 S 5TH ST STE 301
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5862
Practice Address - Country:US
Practice Address - Phone:580-249-3468
Practice Address - Fax:580-234-5028
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01833207X00000X
OK20712207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2077062AOtherMEDICARE ID-TYPE UNSPECIFIED
NC2077062OtherMEDICARE ID-TYPE UNSPECIFIED
OK100188770AMedicaid
NC5916465Medicaid
NC5916465Medicaid
NC2077062AOtherMEDICARE ID-TYPE UNSPECIFIED