Whatley, Jerry David

Whatley, Jerry David is an sole proprietor health care provider with primary practice located at 509 Grand Ave , Ardmore OK 73401-4338. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Whatley, Jerry David can be contacted via phone (580) 223-3300.

Contact Information

Primary practice address
509 Grand Ave Ardmore OK 73401-4338
Phone: (580) 223-3300
Fax: (580) 223-3320
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 207QA0000X 19096 Oklahoma

Profile Details

NPI number 1780634816
LBN Legal business name Whatley, Jerry David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 11th, 2006
Last updated Jan 7th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780634816 NPPES
Oklahoma Other 100114070G SOONERCARE MCD #
Oklahoma Other 19096 SOONERCARE MCD #
Oklahoma Other 731612230 SOONERCARE MCD #
Oklahoma MEDICAID 100114070A SOONERCARE MCD #

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