Healthcare Provider Details

I. General information

NPI: 1285825976
Provider Name (Legal Business Name): JACK B. HOWARD MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARLINGTON ST STE F
ADA OK
74820-4072
US

IV. Provider business mailing address

1201 ARLINGTON ST STE F
ADA OK
74820-4072
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-2626
  • Fax: 580-436-3244
Mailing address:
  • Phone: 580-436-2626
  • Fax: 580-436-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number8314
License Number StateOK

VIII. Authorized Official

Name: DR. JACK B HOWARD
Title or Position: OWNER
Credential: MD
Phone: 580-436-2626