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General NPI Number Information
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NPI Number | 1003051764
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Entity Type | Organization
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Legal Business Name | NATHAN VALENTINE, M.D., PLLC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 2308 NW 158TH ST
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City | EDMOND
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State | OK
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Zip | 73013-9763
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Country | US
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Telephone | 405-887-6515
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Fax | 866-707-6724
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Provider Business Mailing Address
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Address Line | PO BOX 5448
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City | EDMOND
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State | OK
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Zip | 73083-5448
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Country | US
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Telephone | 405-887-6515
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Fax | 866-707-6724
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATHAN ISAAC VALENTINE
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Credential | M.D.
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Telephone | 405-887-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26014
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License Number State | OK
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