Individual
JERRY MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4312 VFW DR. APT # 7, 4312 VFW DR. APT # 7, DEL CITY, OK 73115
(405) 468-0922
Mailing address
4312 VFW DR APT 7, DEL CITY, OK 73115-2139
(405) 468-0922
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/13/2017
Last updated
07/21/2022
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