Individual
JACOB RAY PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
231 E GRAHAM AVE, PRYOR, OK 74361-2436
(918) 782-8110
Mailing address
231 E GRAHAM AVE, PRYOR, OK 74361-2436
(918) 782-8110
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
09/20/2017
Last updated
10/10/2017
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