Individual
MATTHEW RAY WHITTAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4401 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3413
(405) 636-7195
(405) 979-8459
Mailing address
408 S CHESTNUT AVE, BROKEN ARROW, OK 74012-3407
(918) 706-1011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
7054
OK
390200000X
Student in an Organized Health Care Education/Training Program
0335R
OK
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/18/2019
Last updated
10/24/2020
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