Healthcare Provider Details

I. General information

NPI: 1154610046
Provider Name (Legal Business Name): JACOB ADAM KRAJICEK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9020
US

IV. Provider business mailing address

8509 N 102ND EAST AVE
OWASSO OK
74055-2356
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5373
  • Fax:
Mailing address:
  • Phone: 918-576-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number390200000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: