Organization
DIAGNOSTIC RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY M JACKSON (BILLING OFFICE MANAGER)
(405) 348-1900
Entity
Organization
Contact information
Practice address
902 S BRYANT AVE, EDMOND, OK 73034-5742
(405) 348-1900
(405) 348-0423
Mailing address
PO BOX 2080, EDMOND, OK 73083-2080
(405) 348-1900
(405) 348-0423
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734560A
—
OK
Enumeration date
05/17/2006
Last updated
09/20/2010
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