1003107855 NPI number — DR. DARIN ALAN GWARTNEY D.O.

Table of content: DR. DARIN ALAN GWARTNEY D.O. (NPI 1003107855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003107855 NPI number — DR. DARIN ALAN GWARTNEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GWARTNEY
Provider First Name:
DARIN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003107855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 NE 1ST ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PRYOR
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74361-8850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-824-7714
Provider Business Mailing Address Fax Number:
918-824-6412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 NE 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PRYOR
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74361-8850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-824-7714
Provider Business Practice Location Address Fax Number:
918-824-6412
Provider Enumeration Date:
04/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X , with the licence number:  OS017248 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 5219 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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