MEDICARE: DIABETIC CARE OF OKLAHOMA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1356471940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC CARE OF OKLAHOMA

Provider Business Mailing Address
First Line	:	516 W CALIFORNIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-2443
Country	:	US
Telephone Number	:	405-602-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 W CALIFORNIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-2443
Country	:	US
Telephone Number	:	405-602-3000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JIM BREWER
Credential	:
Telephone Number	:	405-401-8000

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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Directions to “DIABETIC CARE OF OKLAHOMA ” Practice Location

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