MEDICARE: AMY LIBEL DARTER MD PC

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

General Provider Information

NPI Number	:	1790964146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY LIBEL DARTER MD PC

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	:
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AMY L DARTER
Credential	:	MD
Telephone Number	:	405-607-4333

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	07/21/2022

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