Individual
ALICE JEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH, DIPABLM
Contact information
Practice address
1921 STONECIPHER BLVD, ADA, OK 74820-3439
(580) 426-3980
Mailing address
1921 STONECIPHER BLVD, ADA, OK 74820-3439
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41283
OK
207Q00000X
Family Medicine Physician
A182562
CA
207Q00000X
Family Medicine Physician
TLL-2022-003
GU
207Q00000X
Family Medicine Physician
V1799
TX
Other
Enumeration date
04/25/2019
Last updated
06/12/2024
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