Healthcare Provider Details

I. General information

NPI: 1952539629
Provider Name (Legal Business Name): JOSHUA A JANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

V. Phone/Fax

Practice location:
  • Phone: 405-552-0926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6214
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6120
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28467
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: