Basic Information
| Provider Information | |||||||||
| NPI: | 1376509828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNKLEBERGER | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9800 BROADWAY EXT STE 201 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731146304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054245426 | ||||||||
| FaxNumber: | 4054245431 | ||||||||
| Practice Location | |||||||||
| Address1: | 9800 BROADWAY EXT STE 201 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054245426 | ||||||||
| FaxNumber: | 4054245431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 939 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.