Healthcare Provider Details

I. General information

NPI: 1821485657
Provider Name (Legal Business Name): JARED LEPLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 11/05/2016
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

744 W 9TH ST
TULSA OK
74127-9020
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-1000
  • Fax:
Mailing address:
  • Phone: 918-599-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6015
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: