Individual
JACK MANQUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1724 S HARVARD AVE, TULSA, OK 74112-6826
(405) 730-6990
(405) 730-6992
Mailing address
1706 S CEDAR AVE, BROKEN ARROW, OK 74012-6407
(586) 214-8344
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7329
OK
2080S0010X
Pediatric Sports Medicine Physician
010269
AZ
Other
Enumeration date
03/30/2020
Last updated
07/01/2025
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