Gonzales, Jordan

Gonzales, Jordan is an individual health care provider with primary practice located at 603 N Grand Ave , Tahlequah OK 74464-2302. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Gonzales, Jordan can be contacted via phone (918) 444-3921.

Contact Information

Primary practice address
603 N Grand Ave Tahlequah OK 74464-2302
Phone: (918) 444-3921
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 830 Oklahoma

Profile Details

NPI number 1154708626
LBN Legal business name Gonzales, Jordan
Credentials ATC, LAT
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2015
Last updated May 4th, 2015 - about 10 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 1154708626 NPPES
Oklahoma Other 63572 NATIONAL ATHLETIC TRAINERS' ASSOCIATION
Oklahoma Other 830 NATIONAL ATHLETIC TRAINERS' ASSOCIATION

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