Individual
DR. JAYSON D AVENMARG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 WALL STREET, POTEAU, OK 74953
(918) 647-8635
(918) 635-3191
Mailing address
PO BOX 689, POTEAU, OK 74953
(918) 647-8635
(918) 635-3191
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27369
OK
208600000X
Surgery Physician
A65237
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A652370
—
CA
05
—
200261060A
—
OK
Enumeration date
06/23/2005
Last updated
03/16/2010
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