Provider Demographics
NPI:1851078059
Name:IDCOKC PLLC
Entity Type:Organization
Organization Name:IDCOKC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-644-6464
Mailing Address - Street 1:4221 S WESTERN AVE STE 4010
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3492
Mailing Address - Country:US
Mailing Address - Phone:405-644-6464
Mailing Address - Fax:405-644-6465
Practice Address - Street 1:4221 S WESTERN AVE STE 4010
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3492
Practice Address - Country:US
Practice Address - Phone:405-644-6464
Practice Address - Fax:405-644-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty