Provider Demographics
NPI:1285825976
Name:JACK B. HOWARD MD LLC
Entity Type:Organization
Organization Name:JACK B. HOWARD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-436-2626
Mailing Address - Street 1:1201 ARLINGTON ST STE F
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4072
Mailing Address - Country:US
Mailing Address - Phone:580-436-2626
Mailing Address - Fax:580-436-3244
Practice Address - Street 1:1201 ARLINGTON ST STE F
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4072
Practice Address - Country:US
Practice Address - Phone:580-436-2626
Practice Address - Fax:580-436-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8314302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKBFFNNMedicare PIN
OKD34827Medicare UPIN