Healthcare Provider Details

I. General information

NPI: 1871627315
Provider Name (Legal Business Name): DR. DAVID C. CAVALLARO, D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date: 08/11/2008
Reactivation Date: 02/02/2011

III. Provider practice location address

7370 S WALKER AVE
OKLAHOMA CITY OK
73139-7628
US

IV. Provider business mailing address

7370 S WALKER AVE
OKLAHOMA CITY OK
73139-7628
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-2333
  • Fax: 405-631-2350
Mailing address:
  • Phone: 405-631-2333
  • Fax: 405-631-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number140
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number140
License Number StateOK

VIII. Authorized Official

Name: DR. DAVID CARL CAVALLARO
Title or Position: CEO
Credential: DPM
Phone: 405-631-2333