MEDICARE: CLIFFORD D MCENTIRE, DPM, INC

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	213E00000X	Podiatrist	115	OK

General Provider Information

NPI Number	:	1518234343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD D MCENTIRE, DPM, INC

Provider Business Mailing Address
First Line	:	1700 EXCHANGE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-3021
Country	:	US
Telephone Number	:	405-235-7411
Fax Number	:	405-232-5705

Provider Business Practice Location Address
First Line	:	1700 EXCHANGE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-3021
Country	:	US
Telephone Number	:	405-235-7411
Fax Number	:	405-232-5705

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLIFFORD D MCENTIRE
Credential	:	DPM
Telephone Number	:	405-235-7411

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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