MEDICARE: JASON CRYTZER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	944	OK
2	363AM0700X	Medical Physician Assistant		OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801883681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CRYTZER P.A.

Provider Business Mailing Address
First Line	:	3200 QUAIL SPRINGS PKWY STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

Provider Business Practice Location Address
First Line	:	3200 QUAIL SPRINGS PKWY STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/22/2015

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