Healthcare Provider Details

I. General information

NPI: 1629076963
Provider Name (Legal Business Name): DANIEL CLAYTON CLINKENBEARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W RENO AVE
OKLAHOMA CITY OK
73107-6632
US

IV. Provider business mailing address

3000 N GRAND BLVD
OKLAHOMA CITY OK
73107-1818
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-6688
  • Fax: 405-330-5591
Mailing address:
  • Phone: 405-632-6688
  • Fax: 844-689-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20222
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20222
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: