Provider Demographics
NPI:1972555993
Name:NODINE, SETH DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:DAVID
Last Name:NODINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1501 N FLORENCE
Mailing Address - Street 2:STE 101
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017
Mailing Address - Country:US
Mailing Address - Phone:918-342-3633
Mailing Address - Fax:918-342-8959
Practice Address - Street 1:1501 N FLORENCE AVE
Practice Address - Street 2:STE 101
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3169
Practice Address - Country:US
Practice Address - Phone:918-342-3633
Practice Address - Fax:918-342-8959
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-05-06
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Provider Licenses
StateLicense IDTaxonomies
OK23476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038990CMedicaid
OK200038990CMedicaid
OKOKAAA2104Medicare PIN
OKI23660Medicare UPIN