Healthcare Provider Details

I. General information

NPI: 1043250103
Provider Name (Legal Business Name): DAN F CRISWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ELK AVE
DUNCAN OK
73533-1572
US

IV. Provider business mailing address

2210 DUNCAN REGIONAL LOOP
DUNCAN OK
73533-1564
US

V. Phone/Fax

Practice location:
  • Phone: 580-251-6644
  • Fax: 580-251-6645
Mailing address:
  • Phone: 580-251-8212
  • Fax: 580-251-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12155
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number12155
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: