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General NPI Number Information
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NPI Number | 1164418356
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Entity Type | Individual
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Provider Name | DEENA DAVE MD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 1202 SW 67TH STR SUITE 2 AND 3
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-250-0324
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Fax | 580-248-4523
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Provider Business Mailing Address
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Address Line | 1202 S.W 67TH STR. SUITE 2 AND 3
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-250-0324
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Fax | 580-248-4523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14395
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License Number State | OK
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