Provider Demographics
NPI:1174742597
Name:SHANTHARAM DARBE M D P C
Entity type:Organization
Organization Name:SHANTHARAM DARBE M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTHARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-840-9999
Mailing Address - Street 1:4601 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4815
Mailing Address - Country:US
Mailing Address - Phone:405-840-9999
Mailing Address - Fax:405-840-9998
Practice Address - Street 1:4601 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4815
Practice Address - Country:US
Practice Address - Phone:405-840-9999
Practice Address - Fax:405-840-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK160242084P0800X
OK25611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty