Individual
JARED PETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 STANTON L YOUNG BLVD # WP1140, OKLAHOMA CITY, OK 73104
(405) 271-4351
(405) 271-8695
Mailing address
PO BOX 26901, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
29929
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57140
OKLAHOMA STATE BUREAU OF NARCOTICS AND DANGEROUS DRUGS CONTROL
OK
Enumeration date
04/23/2013
Last updated
07/03/2018
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