Provider Demographics
NPI:1851431506
Name:GREGORY Y JIA MD INC PC
Entity Type:Organization
Organization Name:GREGORY Y JIA MD INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:X
Authorized Official - Last Name:JIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-256-7377
Mailing Address - Street 1:908 19TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2307
Mailing Address - Country:US
Mailing Address - Phone:580-256-7377
Mailing Address - Fax:580-256-7767
Practice Address - Street 1:908 19TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2307
Practice Address - Country:US
Practice Address - Phone:580-256-7377
Practice Address - Fax:580-256-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19082208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138540AMedicaid
OK300522299Medicare PIN
OK100138540AMedicaid
OKG44832Medicare UPIN