Provider Demographics
NPI:1932169844
Name:JASLOW, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:JASLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 QUAILBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1718
Mailing Address - Country:US
Mailing Address - Phone:405-418-4500
Mailing Address - Fax:405-418-4501
Practice Address - Street 1:13900 QUAILBROOK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1718
Practice Address - Country:US
Practice Address - Phone:405-418-4500
Practice Address - Fax:405-418-4501
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35653207X00000X
OK30618207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17072OtherHARVARD-PILGRIM HEALTHCARE
MA2062283Medicaid
MANX3363OtherMEDICARE PTAN
MAK11237OtherBCBS-MA
MAK11237OtherBCBS-MA
MAK11237Medicare PIN