Healthcare Provider Details

I. General information

NPI: 1205195443
Provider Name (Legal Business Name): JOHN TYLER WHITAKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 36TH ST N
TULSA OK
74106-1953
US

IV. Provider business mailing address

1705 E 19TH ST STE 302
TULSA OK
74104-5410
US

V. Phone/Fax

Practice location:
  • Phone: 918-398-9460
  • Fax: 918-992-2822
Mailing address:
  • Phone: 918-748-7585
  • Fax: 918-403-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5464
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5464
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: