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General NPI Number Information
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NPI Number | 1851431506
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Entity Type | Organization
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Legal Business Name | GREGORY Y JIA MD INC PC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 908 19TH ST SUITE 300
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City | WOODWARD
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State | OK
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Zip | 73801-2307
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Country | US
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Telephone | 580-256-7377
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Fax | 580-256-7767
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Provider Business Mailing Address
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Address Line | 908 19TH ST SUITE 300
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City | WOODWARD
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State | OK
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Zip | 73801-2307
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Country | US
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Telephone | 580-256-7377
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Fax | 580-256-7767
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARY X JIA
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Credential |
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Telephone | 580-256-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 19082
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License Number State | OK
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