Healthcare Provider Details

I. General information

NPI: 1588010656
Provider Name (Legal Business Name): NATHANIEL MONNET ODOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 SW 89TH ST STE 200D
OKLAHOMA CITY OK
73159-7919
US

IV. Provider business mailing address

3110 SW 89TH ST STE 200D
OKLAHOMA CITY OK
73159-7919
US

V. Phone/Fax

Practice location:
  • Phone: 405-906-4059
  • Fax:
Mailing address:
  • Phone: 405-906-4059
  • Fax: 405-920-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32402
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberDR.0066085
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0066085
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: