Provider Demographics
NPI:1962566307
Name:LE, DAVID Q (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Q
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 S. PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6913
Mailing Address - Country:US
Mailing Address - Phone:405-691-9004
Mailing Address - Fax:405-691-9003
Practice Address - Street 1:9315 S PENNSYLVANIA AVE STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6913
Practice Address - Country:US
Practice Address - Phone:405-691-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPOD233213ES0103X
OK233213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200034100BMedicaid
OKOKB5222Medicare PIN
OKV00296Medicare UPIN
OK200034100BMedicaid
OK900522176Medicare PIN