Provider Demographics
NPI:1295551661
Name:JOLLEY, JOHN JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JOLLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:OK
Mailing Address - Zip Code:74563-0301
Mailing Address - Country:US
Mailing Address - Phone:918-413-7587
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 301
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:OK
Practice Address - Zip Code:74563-0301
Practice Address - Country:US
Practice Address - Phone:918-413-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist