Healthcare Provider Details

I. General information

NPI: 1003107855
Provider Name (Legal Business Name): DARIN ALAN GWARTNEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 NE 1ST ST SUITE 400
PRYOR OK
74361-8850
US

IV. Provider business mailing address

1301 NE 1ST ST SUITE 400
PRYOR OK
74361-8850
US

V. Phone/Fax

Practice location:
  • Phone: 918-824-7714
  • Fax: 918-824-6412
Mailing address:
  • Phone: 918-824-7714
  • Fax: 918-824-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS017248
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5219
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: