Organization
GRAND PRAIRIE PEDIATRIC AND ALLERGY CLINIC INC
Active
Organization
GRAND PRAIRIE PEDIATRIC AND ALLERGY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH CHARLES JACKSON MD (PRES)
(405) 721-8090
Entity
Organization
Contact information
Practice address
7301 N COMANCHE AVE, OKLAHOMA CITY, OK 73132
(405) 721-8090
(405) 722-8529
Mailing address
7301 N COMANCHE AVE, OKLAHOMA CITY, OK 73132
(405) 721-8090
(405) 722-8529
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11030
OK
Other
Enumeration date
04/27/2006
Last updated
05/25/2012
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