Individual
DR. JAY K GANNAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4833 INTEGRIS PKWY, SUITE 150, EDMOND, OK 73034-8864
(405) 657-3990
(405) 471-0039
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(405) 657-3990
(405) 471-0039
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
12885
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100129670A
—
OK
Enumeration date
02/01/2006
Last updated
07/21/2017
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