Provider Demographics
NPI:1033912928
Name:MCGLOTHIN, DARIUS DESMOND
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:DESMOND
Last Name:MCGLOTHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 N PENNSYLVANIA AVE APT 1324
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5910
Mailing Address - Country:US
Mailing Address - Phone:405-889-4050
Mailing Address - Fax:
Practice Address - Street 1:4201 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8309
Practice Address - Country:US
Practice Address - Phone:405-889-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT994173729171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator