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Organization
FOOT AND ANKLE CLINIC OF WESTERN OKLAHOMA
Active
Organization
FOOT AND ANKLE CLINIC OF WESTERN OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY DEWAYNE NELSON DPM (OWNER)
(580) 323-5800
Entity
Organization
Contact information
Practice address
1221 COLORADO AVE, STE C, ELK CITY, OK 73644-2800
(580) 225-9955
(580) 225-9954
Mailing address
800 FRISCO AVE, CLINTON, OK 73601-3306
(580) 323-5800
(580) 323-5802
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
230
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200026900A
—
OK
01
—
200522085
MEDICARE GROUP
OK
01
—
P00162625
RAILROAD MEDICARE
OK
Enumeration date
04/28/2008
Last updated
04/28/2008
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