1063647667 NPI number — DR. NATHAN EDWARD MYATT D.O.

Table of content: DR. NATHAN EDWARD MYATT D.O. (NPI 1063647667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063647667 NPI number — DR. NATHAN EDWARD MYATT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYATT
Provider First Name:
NATHAN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063647667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2690
Provider Second Line Business Mailing Address:
GARRISON TOWER, SUITE 4G4250 DEPARTMENT OF RADIOLOGICAL
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-5125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 NE 13TH ST
Provider Second Line Business Practice Location Address:
4G4200
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-5125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4936 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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