Healthcare Provider Details

I. General information

NPI: 1124425129
Provider Name (Legal Business Name): FRANCIS IDADA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NE 13TH ST STE 2G-2300
OKLAHOMA CITY OK
73104-5008
US

IV. Provider business mailing address

940 NE 13TH ST STE 2G-2300
OKLAHOMA CITY OK
73104-5008
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2429
  • Fax:
Mailing address:
  • Phone: 405-271-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number32195
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS1419
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: