Individual
DR. JILLIAN ROSS RILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1011 HONOR HEIGHTS DR, MUSKOGEE, OK 74401-1318
(918) 577-4050
Mailing address
29719 E 770 RD, WAGONER, OK 74467-1015
(918) 406-2567
(918) 485-0014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36052
OK
207Q00000X
Family Medicine Physician
Primary
4553
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200129340A
—
OK
Enumeration date
01/10/2008
Last updated
12/10/2021
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