JERRY DAVID WHATLEY MD NPI 1780634816

NPI Information

NPI: 1780634816
Provider Name: JERRY DAVID WHATLEY, MD
Classification: Family Medicine - 207QA0000X
Entity Type: Individual

Specialization: Adolescent Medicine

Address:
509 GRAND AVE
ARDMORE, OK
ZIP 73401
Phone: (580) 223-3300
Get Directions

Jerry David Whatley, MD is an adolescent medicine family medicine in Ardmore, OK. The provider is a family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. Jerry David Whatley, MD NPI is 1780634816. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

509 GRAND AVE
ARDMORE, OK
ZIP 73401-338
Phone: (580) 223-3300
Fax: (580) 223-3320

The enumeration date for this NPI number is 5/11/2006 and was last updated on 1/7/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0000X	Family Medicine	Adolescent Medicine	19096	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100114070A	MEDICAID	OKLAHOMA
2	100114070G	OTHER	OKLAHOMA	SOONERCARE MCD #
3	731612230	OTHER	OKLAHOMA	TAX ID #
4	19096	OTHER	OKLAHOMA	OKLAHOMA LICENSE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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