Provider Demographics
NPI:1922328772
Name:MACIAS, JASON D (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:MACIAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 N FLORENCE
Mailing Address - Street 2:STE 201
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3189
Mailing Address - Country:US
Mailing Address - Phone:918-341-1886
Mailing Address - Fax:918-343-1727
Practice Address - Street 1:1501 N FLORENCE
Practice Address - Street 2:STE 201
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3189
Practice Address - Country:US
Practice Address - Phone:918-341-1886
Practice Address - Fax:918-343-1727
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2016-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK5044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200493630AMedicaid
OK297202YLV0Medicare PIN