MEDICARE: JAHANYAR JOHN MAKIPOUR, JR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25696	OK

General Provider Information

NPI Number	:	1063618650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAHANYAR JOHN MAKIPOUR, JR MD

Provider Business Mailing Address
First Line	:	333 S 38TH ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-4937
Country	:	US
Telephone Number	:	918-686-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	9020 E RENO AVE FL 2
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-3336
Country	:	US
Telephone Number	:	405-732-7715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	09/16/2020

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