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General NPI Number Information
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NPI Number | 1316127913
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Entity Type | Organization
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Legal Business Name | RYLAN-JAGGER MEDICAL LLC
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 523 S SANTA FE AVE
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City | EDMOND
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State | OK
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Zip | 73003-6226
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Country | US
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Telephone | 405-513-7070
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Fax | 405-513-7071
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Provider Business Mailing Address
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Address Line | PO BOX 99112
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City | OKLAHOMA CITY
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State | OK
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Zip | 73199-0001
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Country | US
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Telephone | 405-513-7070
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Fax | 405-513-7071
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Authorized Official
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Title or Position | PRESIDENT
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Name | DATHAN D JAY
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Credential | MD
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Telephone | 405-513-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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