Provider Demographics
NPI:1568453918
Name:SERATT, JAMES MARK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:SERATT
Suffix:
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:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-0059
Mailing Address - Country:US
Mailing Address - Phone:918-456-6250
Mailing Address - Fax:918-456-4080
Practice Address - Street 1:22408 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2058
Practice Address - Country:US
Practice Address - Phone:918-456-6250
Practice Address - Fax:918-456-4080
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B50543783OtherDEA
OK800522162Medicare ID - Type Unspecified
C95468Medicare UPIN