Provider Demographics
NPI:1518977867
Name:CLAUNCH, JERE D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JERE
Middle Name:D
Last Name:CLAUNCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12301 N WESTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8017
Mailing Address - Country:US
Mailing Address - Phone:405-962-8123
Mailing Address - Fax:405-757-4929
Practice Address - Street 1:12301 N WESTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8017
Practice Address - Country:US
Practice Address - Phone:405-962-8123
Practice Address - Fax:405-757-9294
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ59-749Medicare UPIN