Healthcare Provider Details

I. General information

NPI: 1396580007
Provider Name (Legal Business Name): DADE DORSEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

623 W SKYVIEW DR
HINTON OK
73047-9400
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-7000
  • Fax:
Mailing address:
  • Phone: 405-542-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1133R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: