Healthcare Provider Details

I. General information

NPI: 1336109750
Provider Name (Legal Business Name): AMY L. DARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1250
US

IV. Provider business mailing address

1810 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1250
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-4333
  • Fax: 405-607-4404
Mailing address:
  • Phone: 405-607-4333
  • Fax: 405-607-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20754
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: