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General NPI Number Information
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NPI Number | 1497281802
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Entity Type | Individual
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Provider Name | EDITH MERCEDES DE JESUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 10711 E 11TH ST SUITE 1
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City | TULSA
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State | OK
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Zip | 74128-3200
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Country | US
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Telephone | 918-261-6493
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Fax | 918-583-7205
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Provider Business Mailing Address
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Address Line | 10711 E 11TH ST STE 1 XAVIER CLINIC
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City | TULSA
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State | OK
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Zip | 74128-3212
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Country | US
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Telephone | 918-261-6493
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Fax | 918-583-7205
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 18702
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License Number State | OK
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