Healthcare Provider Details

I. General information

NPI: 1528023066
Provider Name (Legal Business Name): JEAN FELIX CYRIAQUE M.D.,M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16205 N PENNSYLVANIA AVE
EDMOND OK
73013-7325
US

IV. Provider business mailing address

7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK
73145-8716
US

V. Phone/Fax

Practice location:
  • Phone: 919-740-1530
  • Fax:
Mailing address:
  • Phone: 919-740-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27568
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number27568
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: