Healthcare Provider Details

I. General information

NPI: 1447366695
Provider Name (Legal Business Name): CLIFFORD G ALLEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N MAIN ST STE 203
SAND SPRINGS OK
74063-7652
US

IV. Provider business mailing address

214 N MAIN ST STE 203
SAND SPRINGS OK
74063-7652
US

V. Phone/Fax

Practice location:
  • Phone: 918-430-9709
  • Fax:
Mailing address:
  • Phone: 918-430-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number255
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: