Healthcare Provider Details

I. General information

NPI: 1417545724
Provider Name (Legal Business Name): JALAL GONDAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STATON L. YOUNG BLVD
OKLAHOMA CITY OK
73117
US

IV. Provider business mailing address

800 STATON L. YOUNG BLVD
OKLAHOMA CITY OK
73117
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2316
  • Fax:
Mailing address:
  • Phone: 405-271-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43427
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: