Provider Demographics
NPI:1265428098
Name:ORJALA, JON EVERARD (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:EVERARD
Last Name:ORJALA
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 1:10512 N 110TH EAST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6638
Mailing Address - Country:US
Mailing Address - Phone:918-376-8959
Mailing Address - Fax:918-376-8999
Practice Address - Street 1:10512 N 110TH EAST AVE
Practice Address - Street 2:STE 220
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6638
Practice Address - Country:US
Practice Address - Phone:918-376-8959
Practice Address - Fax:918-376-8999
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1159420001OtherDME PROVIDER NUMBER
OK100185170BMedicaid
OKF48777Medicare UPIN
OK100185170BMedicaid