Healthcare Provider Details

I. General information

NPI: 1558567537
Provider Name (Legal Business Name): DARREN ELENBURG DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W MEMORIAL RD
OKLAHOMA CITY OK
73114-2006
US

IV. Provider business mailing address

609 W MEMORIAL RD
OKLAHOMA CITY OK
73114-2006
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-2676
  • Fax: 405-418-2677
Mailing address:
  • Phone: 405-418-2676
  • Fax: 405-418-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number226
License Number StateOK

VIII. Authorized Official

Name: DARREN DEAN ELENBURG
Title or Position: OWNER
Credential: DPM
Phone: 405-418-2676