Individual
DR. JO ELLE GRACE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
940 STANTON L YOUNG BLVD # 451, OKLAHOMA CITY, OK 73104-5020
(713) 206-7708
Mailing address
1122 NE 13TH ST # ORI236, OKLAHOMA CITY, OK 73117-1039
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
30326
OK
207ZP0101X
Anatomic Pathology Physician
Primary
30326
OK
Other
Enumeration date
01/05/2009
Last updated
01/23/2017
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