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Individual

RYAN MICHAEL JACOB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
100 N UNIVERSITY DR, EDMOND, OK 73034-5207
(405) 974-2727
Mailing address
12221 S LAND AVE, OKLAHOMA CITY, OK 73170-4509
(405) 837-2895

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
07/13/2021
Last updated
07/13/2021
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