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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