Individual
JEFFREY LANE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1717 S UTICA AVE STE A, TULSA, OK 74104-5346
(918) 748-7557
(918) 748-7514
Mailing address
1515 N HARVARD AVE, STE E, TULSA, OK 74115-4957
(918) 832-6049
(918) 832-6055
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
16468
OK
Other
Enumeration date
11/11/2006
Last updated
04/13/2010
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