Provider Demographics
NPI:1063453975
Name:SERES, DONNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:SERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 N PORTLAND AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5045
Mailing Address - Country:US
Mailing Address - Phone:405-936-1000
Mailing Address - Fax:405-936-1001
Practice Address - Street 1:11200 N PORTLAND AVE
Practice Address - Street 2:2ND FL
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5045
Practice Address - Country:US
Practice Address - Phone:405-936-1000
Practice Address - Fax:405-936-1001
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22351207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100136950AMedicaid
OK7697670OtherAETNA
OK5618426OtherFIRST HEALTH
137446Medicare UPIN
P00278274Medicare PIN
OK100136950AMedicaid
OK137446Medicare UPIN