Provider Demographics
NPI:1023070679
Name:HADLEY, DAVID LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:HADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3722
Mailing Address - Country:US
Mailing Address - Phone:405-924-0938
Mailing Address - Fax:405-703-5639
Practice Address - Street 1:1920 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3722
Practice Address - Country:US
Practice Address - Phone:405-273-7879
Practice Address - Fax:405-273-7885
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100164890AMedicaid
OK249726402Medicare PIN
OK100164890AMedicaid
OKF88669Medicare UPIN