Individual
JUSTINE DAUTENHAHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1125 N PORTER AVE, SUITE 100, NORMAN, OK 73071-6443
(405) 364-1071
Mailing address
PO BOX 1387, NORMAN, OK 73070-1387
(405) 321-8125
(405) 321-8514
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13103
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100254070B
—
OK
01
—
300047500
RR MEDICARE
OK
Enumeration date
11/08/2005
Last updated
04/27/2010
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