Healthcare Provider Details

I. General information

NPI: 1811391386
Provider Name (Legal Business Name): JM MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 E 57TH ST STE 1
TULSA OK
74145-8645
US

IV. Provider business mailing address

7941 E 57TH ST STE 1
TULSA OK
74145-8645
US

V. Phone/Fax

Practice location:
  • Phone: 918-936-4295
  • Fax:
Mailing address:
  • Phone: 918-936-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M MOORE
Title or Position: OWNER
Credential: MD
Phone: 918-936-4295