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General NPI Number Information
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NPI Number | 1265596969
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Entity Type | Individual
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Provider Name | JON C AXTON MD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 5300 N GRAND BLVD SUITE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5647
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Country | US
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Telephone | 405-942-8545
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Fax | 405-947-6854
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Provider Business Mailing Address
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Address Line | PO BOX 2263
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-2263
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Country | US
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Telephone | 405-942-8545
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Fax | 405-947-6854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 10228
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License Number State | OK
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