Individual
JORDAN NIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
914 NE PHEASANT LN, LAWTON, OK 73507-2327
(580) 284-5453
Mailing address
914 NE PHEASANT LN, LAWTON, OK 73507-2327
(580) 284-5453
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/19/2014
Last updated
02/19/2014
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