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Individual

MR. JERRY WAYNE SPIVEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1215 N KLEIN AVE, OKLAHOMA CITY, OK 73106-4616
(405) 204-0139
Mailing address
1215 N KLEIN AVE, OKLAHOMA CITY, OK 73106-4616
(405) 204-0139

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
OK

Other

Enumeration date
04/12/2007
Last updated
07/08/2007
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Product
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  • Eligibility checks
  • EDI platform