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Organization
JACKSON MEDICAL CLINIC, PC
Active
Organization
JACKSON MEDICAL CLINIC, PC
Active
Other names
JACKSON FAMILY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY NOEL HALEY (OFFICE MANAGER)
(918) 485-5591
Entity
Organization
Contact information
Practice address
410 E CHEROKEE ST, WAGONER, OK 74467-4708
(918) 485-5591
(918) 485-5758
Mailing address
410 E CHEROKEE ST, WAGONER, OK 74467-4708
(918) 485-5591
(918) 485-5758
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
28153
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100141080E
—
OK
Enumeration date
04/17/2009
Last updated
03/22/2017
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