Individual
JACOB LEON CALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5050 E KENOSHA ST, BROKEN ARROW, OK 74014-6711
(918) 994-5140
(918) 994-5150
Mailing address
5050 E KENOSHA ST, BROKEN ARROW, OK 74014-6711
(918) 994-5140
(918) 994-5150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1844
OK
Other
Enumeration date
08/03/2009
Last updated
10/08/2024
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