Provider Demographics
NPI:1669411500
Name:PAMELA A. JARRETT, DO, PC
Entity type:Organization
Organization Name:PAMELA A. JARRETT, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-342-5488
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-1895
Mailing Address - Country:US
Mailing Address - Phone:405-947-5557
Mailing Address - Fax:409-948-6507
Practice Address - Street 1:10630 E 510 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-0326
Practice Address - Country:US
Practice Address - Phone:918-342-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93836Medicare UPIN