Individual
JACOB RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 12TH AVE NE, NORMAN, OK 73071-5238
(405) 573-3842
Mailing address
1840 W BOYD ST, NORMAN, OK 73069-4828
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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