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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