JERRY DAVID WHATLEY MD NPI 1780634816

NPI Information

  • NPI: 1780634816
  • Provider Name: JERRY DAVID WHATLEY, MD
  • Classification: Family Medicine - 207QA0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 509 GRAND AVE
    ARDMORE, OK
    ZIP 73401
  • Phone: (580) 223-3300

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NPI Details

Jerry David Whatley, MD is an adolescent medicine family medicine in Ardmore, OK with 34 years of experience. 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 NPI 1780634816 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

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
1207QA0000XFamily MedicineAdolescent Medicine19096OKLAHOMAYes

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
1100114070AMEDICAIDOKLAHOMA
2100114070GOTHEROKLAHOMASOONERCARE MCD #
3731612230OTHEROKLAHOMATAX ID #
419096OTHEROKLAHOMAOKLAHOMA 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: 11/21/2025

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