# GREGORY Y JIA MD INC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851431506
- **Authorized official:** MRS. MARY X JIA (OFFICE MANAGER)
- **Authorized official phone:** (580) 256-7377

## Contact information

- **Practice address:** 908 19TH ST, SUITE 300, WOODWARD, OK 73801-2307
- **Practice address phone:** (580) 256-7377
- **Practice address fax:** (580) 256-7767
- **Mailing address:** 908 19TH ST, SUITE 300, WOODWARD, OK 73801-2307
- **Mailing address phone:** (580) 256-7377
- **Mailing address fax:** (580) 256-7767

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 19082 | OK | Yes |

## Other

- **Enumeration date:** 02/08/2007
- **Last updated:** 10/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100138540A | — | OK |