Provider Demographics
NPI:1003051764
Name:NATHAN VALENTINE, M.D., PLLC
Entity Type:Organization
Organization Name:NATHAN VALENTINE, M.D., PLLC
Other - Org Name:VALENTINE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-887-6515
Mailing Address - Street 1:PO BOX 5448
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5448
Mailing Address - Country:US
Mailing Address - Phone:405-887-6515
Mailing Address - Fax:866-707-6724
Practice Address - Street 1:2308 NW 158TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9763
Practice Address - Country:US
Practice Address - Phone:405-887-6515
Practice Address - Fax:866-707-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty