Healthcare Provider Details

I. General information

NPI: 1144505017
Provider Name (Legal Business Name): JAMAAL A. DYER BHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 W. HASKELL PLACE
TULSA OK
74127-4910
US

IV. Provider business mailing address

1903 W HASKELL PL
TULSA OK
74127-4910
US

V. Phone/Fax

Practice location:
  • Phone: 918-406-6274
  • Fax:
Mailing address:
  • Phone: 918-406-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: