1881628758 NPI number — JASMINE R GADDY M.D.

Table of content: JASMINE R GADDY M.D. (NPI 1881628758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881628758 NPI number — JASMINE R GADDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GADDY
Provider First Name:
JASMINE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881628758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 NE 13TH ST # 54
Provider Second Line Business Mailing Address:
DEPARTMENT OF RHEUMATOLOGY
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-271-7217
Provider Business Mailing Address Fax Number:
405-271-7256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 NE 13TH ST # 54
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RHEUMATOLOGY
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-7217
Provider Business Practice Location Address Fax Number:
405-271-7256
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M3227 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: M3227 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BG9680833 . This is a "US CONTROLLED SUBSTANCE" identifier . This identifiers is of the category "OTHER".




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