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General NPI Number Information
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NPI Number | 1306200548
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Entity Type | Individual
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Provider Name | MR. JONATHAN PAUL ROHLOFF
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Gender | Male
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 4 E CLARK BASS BLVD SUITE 300
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City | MCALESTER
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State | OK
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Zip | 74501-4269
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Country | US
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Telephone | 918-421-6795
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Fax | 918-421-6791
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Provider Business Mailing Address
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Address Line | 2259 GREEN MEADOWS CIR
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City | MCALESTER
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State | OK
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Zip | 74501-3245
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Country | US
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Telephone | 402-320-0715
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6242
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License Number State | OK
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