Individual
DR. DARYL E BIRDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4417 W GORE BLVD, SUITE 2, LAWTON, OK 73505-5978
(580) 248-7417
(580) 248-4847
Mailing address
4417 W GORE BLVD, SUITE 2, LAWTON, OK 73505-5978
(580) 248-7417
(580) 248-4847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10548OK
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10548OK
STATE LIC
OK
Enumeration date
08/25/2006
Last updated
03/07/2023
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