Individual
DEZJUAN VONTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10461 N MAY AVE, OKLAHOMA CITY, OK 73120-2610
(405) 543-6314
Mailing address
10461 N MAY AVE, OKLAHOMA CITY, OK 73120-2610
(405) 543-6314
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
314007
OK
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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