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General NPI Number Information
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NPI Number | 1407218639
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Entity Type | Individual
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Provider Name | JAY ROBERT ANDERSON DO
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Gender | Male
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Dates
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Enumeration Date | 03/26/2016
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 591 E 36TH ST N
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City | TULSA
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State | OK
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Zip | 74106-1812
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Country | US
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Telephone | 918-619-4400
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Fax | 918-634-7875
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Provider Business Mailing Address
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Address Line | PO BOX 268838
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8838
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Country | US
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Telephone | 918-660-3632
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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 | 8830
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License Number State | OK
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