Provider Demographics
NPI:1861468548
Name:ADKISSON, JOEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:A
Last Name:ADKISSON
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 1:517 S ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2296
Mailing Address - Country:US
Mailing Address - Phone:918-459-0027
Mailing Address - Fax:918-250-0457
Practice Address - Street 1:517 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2296
Practice Address - Country:US
Practice Address - Phone:918-459-0027
Practice Address - Fax:918-250-0457
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG55423Medicare UPIN