Healthcare Provider Details

I. General information

NPI: 1013901461
Provider Name (Legal Business Name): DANIEL DEAN WASHBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E OKLAHOMA AVE STE 208
ENID OK
73701-5952
US

IV. Provider business mailing address

PO BOX 3046
MALVERN PA
19355-0746
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-3090
  • Fax: 580-234-2090
Mailing address:
  • Phone: 580-242-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11337
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11337
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: