Healthcare Provider Details

I. General information

NPI: 1518234343
Provider Name (Legal Business Name): CLIFFORD D MCENTIRE, DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EXCHANGE AVE
OKLAHOMA CITY OK
73108-3021
US

IV. Provider business mailing address

1700 EXCHANGE AVE
OKLAHOMA CITY OK
73108-3021
US

V. Phone/Fax

Practice location:
  • Phone: 405-235-7411
  • Fax: 405-232-5705
Mailing address:
  • Phone: 405-235-7411
  • Fax: 405-232-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number115
License Number StateOK

VIII. Authorized Official

Name: DR. CLIFFORD D MCENTIRE
Title or Position: OWNER
Credential: DPM
Phone: 405-235-7411