Provider Demographics
NPI:1962425983
Name:NUNLEY, OMER RAYMOND JR (MD)
Entity type:Individual
Prefix:DR
First Name:OMER
Middle Name:RAYMOND
Last Name:NUNLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N FAIRLAND ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4231
Mailing Address - Country:US
Mailing Address - Phone:918-825-1957
Mailing Address - Fax:918-825-6930
Practice Address - Street 1:133 N FAIRLAND ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4231
Practice Address - Country:US
Practice Address - Phone:918-825-1957
Practice Address - Fax:918-825-6930
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9809208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100117040BMedicaid
C95309Medicare UPIN
OK100117040BMedicaid