MEDICARE: GREGORY Y JIA M.D.

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	208800000X	Urology Physician	19082	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922084128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY Y JIA M.D.

Provider Business Mailing Address
First Line	:	5300 N INDEPENDENCE AVE STE 280
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5555
Country	:	US
Telephone Number	:	405-636-7499
Fax Number	:	405-636-7809

Provider Business Practice Location Address
First Line	:	4200 S DOUGLAS AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3215
Country	:	US
Telephone Number	:	405-636-7499
Fax Number	:	405-636-7809

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	01/11/2021

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