Healthcare Provider Details

I. General information

NPI: 1902420508
Provider Name (Legal Business Name): NATHAN JOHN ALDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 500
OKLAHOMA CITY OK
73120-8300
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 500
OKLAHOMA CITY OK
73120-8300
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4230
  • Fax: 405-749-4228
Mailing address:
  • Phone: 405-749-4230
  • Fax: 405-749-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number36058
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: