Provider Demographics
NPI:1629218151
Name:NATHAN VALENTINE MD PLLC
Entity Type:Organization
Organization Name:NATHAN VALENTINE MD PLLC
Other - Org Name:VALENTINE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-887-6515
Mailing Address - Street 1:3140 W BRITTON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2074
Mailing Address - Country:US
Mailing Address - Phone:405-887-6515
Mailing Address - Fax:858-373-1870
Practice Address - Street 1:3140 W BRITTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2074
Practice Address - Country:US
Practice Address - Phone:405-887-6515
Practice Address - Fax:858-373-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty