Healthcare Provider Details

I. General information

NPI: 1275553976
Provider Name (Legal Business Name): JAMES FRANKLIN MADISON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

IV. Provider business mailing address

3211 JEANNIE LN
MUSKOGEE OK
74403-7775
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4500
  • Fax:
Mailing address:
  • Phone: 918-360-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA463
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: