Healthcare Provider Details

I. General information

NPI: 1831164458
Provider Name (Legal Business Name): MANUEL CARL LIMBAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: M. CARL LIMBAUGH MD

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 S KELLY AVE
EDMOND OK
73013-3651
US

IV. Provider business mailing address

14024 QUAIL POINTE DR.
OKLAHOMA CITY OK
73134
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-8829
  • Fax: 405-315-1152
Mailing address:
  • Phone: 405-419-8447
  • Fax: 405-419-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16102
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: