Healthcare Provider Details

I. General information

NPI: 1366739351
Provider Name (Legal Business Name): DLW, INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 S WESTERN AVE
OKLAHOMA CITY OK
73170-5819
US

IV. Provider business mailing address

PO BOX 1070
MUSTANG OK
73064-8070
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-3041
  • Fax: 405-735-3146
Mailing address:
  • Phone: 405-512-6950
  • Fax: 405-512-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3500
License Number StateOK

VIII. Authorized Official

Name: DR. DARRIN L WEBSTER
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 405-735-3041