Healthcare Provider Details

I. General information

NPI: 1821544487
Provider Name (Legal Business Name): JORDAN BILBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 E 46TH PL
TULSA OK
74145-6305
US

IV. Provider business mailing address

4845 S. SHERIDAN SUITE 510
TULSA OK
74145-5719
US

V. Phone/Fax

Practice location:
  • Phone: 918-384-0002
  • Fax: 918-384-0004
Mailing address:
  • Phone: 918-384-0002
  • Fax: 918-384-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: