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NPI Code Detail

MEDICARE: JOE PELLOW

MEDICARE: JOE PELLOW
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1972088714
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOE PELLOW
Provider Business Mailing Address
First Line : 6904 BRIARCREEK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-7214
Country : US
Telephone Number : 405-209-0227
Fax Number :
Provider Business Practice Location Address
First Line : 6904 BRIARCREEK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-7214
Country : US
Telephone Number : 405-209-0227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2018
Last Update Date : 09/27/2018

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Directions to “ JOE PELLOW ” Practice Location

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