Healthcare Provider Details

I. General information

NPI: 1003809583
Provider Name (Legal Business Name): TERRY M NAYFA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 NW 50TH ST
OKLAHOMA CITY OK
73112-5642
US

IV. Provider business mailing address

3612 NW 50TH ST
OKLAHOMA CITY OK
73112-5642
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-5492
  • Fax: 405-947-5532
Mailing address:
  • Phone: 405-947-5492
  • Fax: 405-947-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number147
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: