Individual
DR. JASON BULENT TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2900 S TELEPHONE RD STE 250, MOORE, OK 73160
(814) 232-1477
Mailing address
15705 HATTERLY LN, EDMOND, OK 73013-4179
(814) 232-1477
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6304
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/22/2011
Last updated
07/26/2018
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