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Organization
FAMILY CARE OF BROKEN ARROW, INC.
Active
Organization
FAMILY CARE OF BROKEN ARROW, INC.
Active
Other names
Family Medicine Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEROY O. JESKE D.O. (MEDICAL DIRECTOR D.O.)
(918) 455-7777
Entity
Organization
Contact information
Practice address
3100 S. ELM PL., SUITE A, BROKEN ARROW, OK 74012-7910
(918) 455-7777
(918) 455-8105
Mailing address
3100 S. ELM PL., SUITE A, BROKEN ARROW, OK 74012-7910
(918) 455-7777
(918) 455-8105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0749960001
PTAN/DMERC
OK
01
—
CS2603
RAILROAD MEDICARE
OK
Enumeration date
03/30/2007
Last updated
04/20/2008
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