Individual
TRAVIS JEREMY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2345 SOUTHWEST BLVD, TULSA, OK 74107-2705
(918) 582-1980
Mailing address
1910 S FALCON AVE, CLAREMORE, OK 74019-2237
(918) 582-1980
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5603
OK
Other
Enumeration date
03/08/2013
Last updated
07/01/2016
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