MEDICARE: MS. JESTINE A GAHAGAN X RAY TECHNICIAN

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	2085B0100X	Body Imaging Physician	259819	OK

General Provider Information

NPI Number	:	1851380703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESTINE A GAHAGAN X RAY TECHNICIAN

Provider Business Mailing Address
First Line	:	603 E PINE ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4849
Country	:	US
Telephone Number	:	918-295-6137
Fax Number	:	918-582-0529

Provider Business Practice Location Address
First Line	:	603 E PINE ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-4849
Country	:	US
Telephone Number	:	918-295-6137
Fax Number	:	918-582-0529

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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