Individual
JORDAN WAYNE EIPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4912 S DETROIT AVE, TULSA, OK 74105-4610
(918) 346-7878
Mailing address
4912 S DETROIT AVE, TULSA, OK 74105-4610
(918) 346-7878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4539
OK
Other
Enumeration date
09/25/2019
Last updated
02/22/2021
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