Healthcare Provider Details

I. General information

NPI: 1205806759
Provider Name (Legal Business Name): JASON LLOYD HILL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

RR 2 BOX 1660
TALIHINA OK
74571-9516
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7113
Mailing address:
  • Phone: 918-567-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3763
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: