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General NPI Number Information
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NPI Number | 1972555993
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Entity Type | Individual
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Provider Name | SETH DAVID NODINE MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 1501 N FLORENCE AVE STE 101
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City | CLAREMORE
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State | OK
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Zip | 74017-3169
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Country | US
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Telephone | 918-342-3633
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Fax | 918-342-8959
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Provider Business Mailing Address
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Address Line | 1501 N FLORENCE STE 101
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City | CLAREMORE
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State | OK
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Zip | 74017
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Country | US
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Telephone | 918-342-3633
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Fax | 918-342-8959
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 23476
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License Number State | OK
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