Provider Demographics
NPI:1346476975
Name:LEDET, JOHNATHAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:JAMES
Last Name:LEDET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6045
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6565 S YALE AVE STE 1200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-502-3376
Practice Address - Fax:918-502-3375
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8742207N00000X
OK33281207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program