Provider Demographics
NPI:1629389432
Name:MUEGGENBORG, JARROD JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:JAMES
Last Name:MUEGGENBORG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 S DOUGLAS AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3223
Mailing Address - Country:US
Mailing Address - Phone:405-636-7195
Mailing Address - Fax:
Practice Address - Street 1:4200 S DOUGLAS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3223
Practice Address - Country:US
Practice Address - Phone:405-636-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4935207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200297210AMedicaid
OK200297210AMedicaid