Avenmarg, Jayson D

Avenmarg, Jayson D is an individual health care provider with primary practice located at 104 Wall Street , Poteau OK 74953. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Avenmarg, Jayson D can be contacted via phone (918) 647-8635.

Contact Information

Primary practice address
104 Wall Street Poteau OK 74953
Phone: (918) 647-8635
Fax: (918) 635-3191
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X A65237 California
Allopathic & Osteopathic Physicians / Surgery 208600000X 27369 Oklahoma

Profile Details

NPI number 1093711053
LBN Legal business name Avenmarg, Jayson D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2005
Last updated Mar 16th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093711053 NPPES
Oklahoma MEDICAID 200261060A
Oklahoma MEDICAID 00A652370

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