# DARYL E. BIRDWELL, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972631067
- **Authorized official:** MRS. DIANNA SIMMONS (OFFICE MANAGER)
- **Authorized official phone:** (580) 248-7417

## Contact information

- **Practice address:** 4417 W GORE BLVD STE 2, LAWTON, OK 73505-5978
- **Practice address phone:** (580) 248-7417
- **Practice address fax:** (580) 248-4847
- **Mailing address:** 4417 W GORE BLVD STE 2, LAWTON, OK 73505-5978
- **Mailing address phone:** (580) 248-7417
- **Mailing address fax:** (580) 248-4847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 10548OK | OK | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 09/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100094050A | — | OK |
| 01 | — | 10548OK | STATE LIC. | OK |