Individual
JOSE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4300 W MEMORIAL RD, ER DEPT, OKLAHOMA CITY, OK 73120-8304
(405) 752-3733
(405) 749-4557
Mailing address
4401 W MEMORIAL RD, SUITE 140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1575
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200105850A
—
OK
Enumeration date
02/06/2007
Last updated
05/02/2014
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