Provider Demographics
NPI:1699838490
Name:GORDON, JAY M (R N)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:GORDON
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 E OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-5008
Mailing Address - Country:US
Mailing Address - Phone:918-258-8571
Mailing Address - Fax:
Practice Address - Street 1:6666 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1756
Practice Address - Country:US
Practice Address - Phone:918-493-2727
Practice Address - Fax:918-493-2990
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0070280163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy