| Daryl E. Birdwell, M.d., Inc. | |
|
4417 W Gore Blvd Ste 2 Lawton OK 73505-5978 | |
| (580) 248-7417 | |
| (580) 248-4847 |
| Full Name | Daryl E. Birdwell, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4417 W Gore Blvd Ste 2, Lawton, Oklahoma |
| Authorized Official Name and Position | Dianna Simmons (OFFICE MANAGER) |
| Authorized Official Contact | 5802487417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daryl E. Birdwell, M.d., Inc. 4417 W Gore Blvd Ste 2 Lawton OK 73505-5978 Ph: (580) 248-7417 | Daryl E. Birdwell, M.d., Inc. 4417 W Gore Blvd Ste 2 Lawton OK 73505-5978 Ph: (580) 248-7417 |
| NPI Number | 1972631067 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 09/22/2010 |
| Medicare PECOS PAC ID | 4789716325 |
|---|---|
| Medicare Enrollment ID | O20100719000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972631067 | NPI | - | NPPES |
| 10548OK | Other | OK | STATE LIC. |
| 100094050A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 10548OK (Oklahoma) | Primary |
| Provider Name | Daryl E Birdwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639287378 PECOS PAC ID: 8921130642 Enrollment ID: I20100715000836 |
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