Healthcare Provider Details

I. General information

NPI: 1356004147
Provider Name (Legal Business Name): JASON CARL DRENNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE 11TH ST
OKLAHOMA CITY OK
73117-2605
US

IV. Provider business mailing address

1501 NE 11TH ST
OKLAHOMA CITY OK
73117-2605
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-1158
  • Fax: 405-424-1198
Mailing address:
  • Phone: 405-230-1158
  • Fax: 405-424-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: