Healthcare Provider Details

I. General information

NPI: 1144607508
Provider Name (Legal Business Name): JOHNATHAN DOOLITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST # 5F
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

538 BROOKHURST DR
DALLAS TX
75218-2128
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6452
  • Fax: 405-271-6219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number38520
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.139466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: