Provider Demographics
NPI:1740215680
Name:FLANARY, CLAYTON WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:WAYNE
Last Name:FLANARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-3893
Mailing Address - Country:US
Mailing Address - Phone:918-652-9650
Mailing Address - Fax:918-652-7827
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-3893
Practice Address - Country:US
Practice Address - Phone:918-652-9650
Practice Address - Fax:918-652-7827
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126360AMedicaid
OK100126360AMedicaid
243425201Medicare ID - Type Unspecified