Healthcare Provider Details

I. General information

NPI: 1760147664
Provider Name (Legal Business Name): ELIZABETH DISALVATORE MHS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N WHISENANT DR
DUNCAN OK
73533-1650
US

IV. Provider business mailing address

1415 N WHISENANT DR
DUNCAN OK
73533-1650
US

V. Phone/Fax

Practice location:
  • Phone: 580-252-5300
  • Fax:
Mailing address:
  • Phone: 580-252-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4688
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: