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Individual

DR. JOHN JAMES DITMARS JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
1620 W ELM ST, EL RENO, OK 73036-4202
(405) 262-6613
(405) 262-1088
Mailing address
PO BOX 610, EL RENO, OK 73036-0610
(405) 262-6613
(405) 262-1088

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
142
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100780220A
OK
01
480019883
RR MEDICARE
OK
01
73-1490445-003
BLUE CROSS & BLUE SHIELD
OK
Enumeration date
07/06/2006
Last updated
06/06/2013
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