Healthcare Provider Details

I. General information

NPI: 1871024349
Provider Name (Legal Business Name): JONES PHILIP THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S WESTERN AVE STE 2010
OKLAHOMA CITY OK
73109-3445
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5120
  • Fax: 405-644-5309
Mailing address:
  • Phone: 216-844-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39503
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: