Healthcare Provider Details

I. General information

NPI: 1659052033
Provider Name (Legal Business Name): ABDULLAH ALJUDAIBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N MONTE VISTA ST
ADA OK
74820-4610
US

IV. Provider business mailing address

430 N MONTE VISTA ST
ADA OK
74820-4657
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-2323
  • Fax:
Mailing address:
  • Phone: 580-332-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50512
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: