Provider Demographics
NPI:1497269435
Name:JAKES, WILL RODGERS I
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:RODGERS
Last Name:JAKES
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 PINE OAK PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5437
Mailing Address - Country:US
Mailing Address - Phone:405-305-9082
Mailing Address - Fax:
Practice Address - Street 1:1406 PINE OAK PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5437
Practice Address - Country:US
Practice Address - Phone:405-305-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist