Provider Demographics
NPI:1780607705
Name:SARFATIS, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SARFATIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N FAIRLAND ST
Mailing Address - Street 2:STE 108
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4228
Mailing Address - Country:US
Mailing Address - Phone:918-825-2070
Mailing Address - Fax:918-825-0231
Practice Address - Street 1:109 N FAIRLAND ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4228
Practice Address - Country:US
Practice Address - Phone:918-825-2070
Practice Address - Fax:918-825-0231
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK9108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100254060AMedicaid
243425305Medicare ID - Type Unspecified
OK100254060AMedicaid