Healthcare Provider Details

I. General information

NPI: 1861531139
Provider Name (Legal Business Name): JONATHAN MARTIN PILLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 S BOULEVARD SUITE 160
EDMOND OK
73013-5778
US

IV. Provider business mailing address

3033 NW 63RD ST SUITE 152E
OKLAHOMA CITY OK
73116-3634
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-1810
  • Fax: 405-562-1816
Mailing address:
  • Phone: 405-755-6651
  • Fax: 405-755-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23979
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: