Provider Demographics
NPI:1831164458
Name:LIMBAUGH, MANUEL CARL (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:CARL
Last Name:LIMBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:CARL
Other - Last Name:LIMBAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14024 QUAIL POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-419-8447
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:1616 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3651
Practice Address - Country:US
Practice Address - Phone:405-341-8829
Practice Address - Fax:405-315-1152
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE10834Medicare UPIN