Provider Demographics
NPI:1568885416
Name:OKLAHOMA SPINE AND MUSCULOSKELETAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA SPINE AND MUSCULOSKELETAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-601-5899
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-601-5899
Mailing Address - Fax:405-601-5903
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1212
Practice Address - Country:US
Practice Address - Phone:405-601-5899
Practice Address - Fax:405-601-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48712081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty