Individual
LONNIE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3100 MEDICAL PKWY, CLAREMORE, OK 74017-1088
(918) 342-0770
Mailing address
3100 MEDICAL PKWY, CLAREMORE, OK 74017-1088
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/10/2022
Last updated
06/10/2022
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