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General NPI Number Information
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NPI Number | 1821264920
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CLINIC OF WESTERN OKLAHOMA, PLLC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 900 N MAIN ST
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City | ELK CITY
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State | OK
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Zip | 73644-9998
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Country | US
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Telephone | 580-225-9955
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Fax | 580-225-9954
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Provider Business Mailing Address
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Address Line | 207 S 30TH STREET
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City | CLINTON
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State | OK
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Zip | 73601
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Country | US
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Telephone | 580-323-5800
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Fax | 580-323-5802
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY DEWAYNE NELSON
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Credential | DPM
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Telephone | 580-323-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 230
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License Number State | OK
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