Provider Demographics
NPI:1144215971
Name:NIGHTENGALE, MARK L (M D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:NIGHTENGALE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0305
Mailing Address - Country:US
Mailing Address - Phone:918-481-4706
Mailing Address - Fax:918-481-4765
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-4706
Practice Address - Fax:918-481-4765
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18311207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131480AMedicaid
OKE19521Medicare UPIN