Individual
DEEPAK S. JAISWAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
702 BRYAN DR, SUITE 100, DURANT, OK 74701-7000
(580) 924-4704
(580) 924-6001
Mailing address
702 BRYAN DR, SUITE 100, DURANT, OK 74701-7000
(580) 924-4704
(580) 924-6001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18645
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100207270A
—
OK
01
—
100207270B
INDIVIDUAL MK NUMBER
OK
01
—
242323400
INDIVIDUAL MC NUMBER
OK
Enumeration date
05/20/2006
Last updated
04/12/2011
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