Healthcare Provider Details

I. General information

NPI: 1407485469
Provider Name (Legal Business Name): BROOKS DANIEL WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 S BOULEVARD STE 101
EDMOND OK
73013-5888
US

IV. Provider business mailing address

1455 S DOUGLAS BLVD STE D
MIDWEST CITY OK
73130-5269
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-5252
  • Fax: 405-726-8530
Mailing address:
  • Phone: 636-227-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number43503
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: