Basic Information
| Provider Information | |||||||||
| NPI: | 1063453975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SERES | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11200 N PORTLAND AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731205045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059361000 | ||||||||
| FaxNumber: | 4059361001 | ||||||||
| Practice Location | |||||||||
| Address1: | 11200 N PORTLAND AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731205045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059361000 | ||||||||
| FaxNumber: | 4059361001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 07/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22351 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100136950A | 05 | OK | MEDICAID | 7697670 | 01 | OK | AETNA | OTHER | 5618426 | 01 | OK | FIRST HEALTH | OTHER |