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General NPI Number Information
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NPI Number | 1588521413
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Entity Type | Individual
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Provider Name | JERSON PENAFLOR
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Gender | Male
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 905 S MAIN ST
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City | SHATTUCK
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State | OK
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Zip | 73858-9205
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Country | US
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Telephone | 580-938-5518
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Fax | 580-938-5335
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Provider Business Mailing Address
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Address Line | 1118 S SUMMER ST
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City | SHATTUCK
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State | OK
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Zip | 73858-9424
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Country | US
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Telephone | 580-216-5036
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State |
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