Healthcare Provider Details

I. General information

NPI: 1790163467
Provider Name (Legal Business Name): JARED PRESTON HIGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N. PORTLAND AVE. STE 440
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

5401 N. PORTLAND AVE. STE 440
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-1137
  • Fax: 405-947-0731
Mailing address:
  • Phone: 405-943-1137
  • Fax: 405-947-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number31508
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: