Healthcare Provider Details

I. General information

NPI: 1245361500
Provider Name (Legal Business Name): JEFFREY PAUL PARDEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 SW 104TH ST
OKLAHOMA CITY OK
73139-2990
US

IV. Provider business mailing address

1006 SW 104TH ST
OKLAHOMA CITY OK
73139-2990
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-1006
  • Fax:
Mailing address:
  • Phone: 405-691-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number10866
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: