Individual
JEREMIE OLLISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6039 BERRY ST, RAHC, FORT SILL, OK 73503
(580) 442-4739
Mailing address
6039 BERRY ST, FORT SILL, OK 73503-4445
(580) 442-4739
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1127053
—
Other
Enumeration date
07/07/2015
Last updated
07/18/2023
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