Individual
JERRY B VANNATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 NE 10TH ST, OUPB 4300, OKLAHOMA CITY, OK 73104-5417
(405) 271-3445
Mailing address
1122 NE 13TH ST, ORI 236, OKLAHOMA CITY, OK 73117-1039
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10842
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100825370D
—
OK
01
—
731069170077
BCBS
OK
Enumeration date
03/17/2006
Last updated
01/24/2011
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