Provider Demographics
NPI:1700877040
Name:FLATT, GERALD WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:WAYNE
Last Name:FLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:G
Other - Middle Name:WAYNE
Other - Last Name:FLATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:603 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2636
Mailing Address - Country:US
Mailing Address - Phone:580-298-3351
Mailing Address - Fax:580-298-3803
Practice Address - Street 1:603 NE 2ND ST
Practice Address - Street 2:ROWLAND FLATT CLINIC
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2636
Practice Address - Country:US
Practice Address - Phone:580-298-3351
Practice Address - Fax:580-298-3803
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10089730AMedicaid
OKE09619Medicare UPIN