Provider Demographics
NPI:1588646988
Name:PITTMAN, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11220 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2725
Mailing Address - Country:US
Mailing Address - Phone:405-722-9474
Mailing Address - Fax:405-722-9463
Practice Address - Street 1:11220 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2725
Practice Address - Country:US
Practice Address - Phone:405-722-9474
Practice Address - Fax:405-722-9463
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2015-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK13230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100082890AMedicaid
OK100082890AMedicaid