Provider Demographics
NPI:1508831447
Name:BOREN, NATHAN ALTUS JR (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALTUS
Last Name:BOREN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 ELM AVE
Mailing Address - Street 2:O.U. HEALTH SERVICES
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-3146
Mailing Address - Country:US
Mailing Address - Phone:405-325-4611
Mailing Address - Fax:405-325-7065
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:O.U. HEALTH SERVICES
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-3146
Practice Address - Country:US
Practice Address - Phone:405-325-4611
Practice Address - Fax:405-325-7065
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G65921Medicare UPIN
OK243322304Medicare ID - Type Unspecified