Provider Demographics
NPI:1568483758
Name:SUBERA, LAYNE EVAN (DO)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:EVAN
Last Name:SUBERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0428
Mailing Address - Country:US
Mailing Address - Phone:918-396-1262
Mailing Address - Fax:918-396-4598
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1211
Practice Address - Country:US
Practice Address - Phone:918-396-1262
Practice Address - Fax:918-396-4598
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG31189Medicare UPIN