Healthcare Provider Details

I. General information

NPI: 1265419691
Provider Name (Legal Business Name): DAVID K ESLICKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE FRANK PHILLIPS BLVD SUITE 202
BARTLESVILLE OK
74003-3913
US

IV. Provider business mailing address

501 SE FRANK PHILLIPS BLVD SUITE 202
BARTLESVILLE OK
74003-3913
US

V. Phone/Fax

Practice location:
  • Phone: 918-336-5454
  • Fax: 918-336-4449
Mailing address:
  • Phone: 918-336-5454
  • Fax: 918-336-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2149
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: