Individual
MR. RANDY SCOTT JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA
Contact information
Practice address
4500 S GARNETT RD, TULSA, OK 74146-5229
(918) 728-6194
(918) 664-0267
Mailing address
3227 S 16TH ST, BROKEN ARROW, OK 74012-1801
(918) 728-6194
(918) 664-0267
Taxonomy
Speciality
Code
Description
License number
State
243U00000X
Radiology Practitioner Assistant
Primary
279995
OK
Other
Enumeration date
04/18/2012
Last updated
04/18/2012
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