Healthcare Provider Details

I. General information

NPI: 1437083789
Provider Name (Legal Business Name): JORDAN CLAYTON MARTIN DRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N EIGHT TRIBES TRL UNIT B
MIAMI OK
74354-1010
US

IV. Provider business mailing address

21 N EIGHT TRIBES TRL UNIT B
MIAMI OK
74354-1010
US

V. Phone/Fax

Practice location:
  • Phone: 918-387-8720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: