Provider Demographics
NPI:1699786483
Name:GUTHRIE, DONALD A JR (PA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:GUTHRIE
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6300 NW EXPRESSWAY STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5128
Mailing Address - Country:US
Mailing Address - Phone:405-445-3697
Mailing Address - Fax:405-212-5571
Practice Address - Street 1:1211 N SHARTEL
Practice Address - Street 2:SUITE 900
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2477
Practice Address - Country:US
Practice Address - Phone:405-235-5331
Practice Address - Fax:405-235-0825
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK343363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR10955Medicare UPIN