Organization
JAISWAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEEPAK S JAISWAL MD (OWNER)
(580) 924-4704
Entity
Organization
Contact information
Practice address
702 BRYAN DR, SUITE 100, DURANT, OK 74701-7031
(580) 924-4704
(580) 924-6001
Mailing address
PO BOX 1514, DURANT, OK 74702-1514
(580) 924-4704
(580) 924-6001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225296361
GROUP NPI
—
01
—
1386698728
INDIVIDUAL NPI
OK
05
—
200198250A
—
OK
Enumeration date
05/27/2008
Last updated
02/01/2012
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