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General NPI Number Information
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NPI Number | 1073537692
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Entity Type | Organization
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Legal Business Name | JETRAD LLC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5825 TULAKES AVE
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City | BETHANY
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State | OK
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Zip | 73008-7009
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Country | US
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Telephone | 405-709-1043
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Fax |
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Provider Business Mailing Address
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Address Line | 5825 TULAKES AVE
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City | BETHANY
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State | OK
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Zip | 73008-7009
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Country | US
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Telephone | 405-709-1043
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX AVERY WEEKS
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Credential |
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Telephone | 405-789-3889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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