Healthcare Provider Details

I. General information

NPI: 1063756708
Provider Name (Legal Business Name): JOJIN ANGELO MATHEWS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. JOJIN ANGELO JOSE

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 1-301
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE SUITE1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-3200
  • Fax: 918-502-3205
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2360
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5311
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: