Healthcare Provider Details

I. General information

NPI: 1811309768
Provider Name (Legal Business Name): JASON SCHRODER D.O, M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

744 W 9TH ST
TULSA OK
74127-9020
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5811
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: