MEDICARE: DR. AMY L. DARTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	20754	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790964146	OTHER	OK	GROUP NPI

General Provider Information

NPI Number	:	1336109750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY L. DARTER M.D.

Provider Business Mailing Address
First Line	:	1810 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1250
Country	:	US
Telephone Number	:	405-607-4333
Fax Number	:	405-607-4404

Provider Business Practice Location Address
First Line	:	1810 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1250
Country	:	US
Telephone Number	:	405-607-4333
Fax Number	:	405-607-4404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	06/22/2017

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