Provider Demographics
NPI:1952373326
Name:MCLAUGHLIN, JERRY T (PA)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:T
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3110 SW 89TH ST STE 200E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7919
Mailing Address - Country:US
Mailing Address - Phone:405-733-7300
Mailing Address - Fax:405-733-7333
Practice Address - Street 1:3110 SW 89TH ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7920
Practice Address - Country:US
Practice Address - Phone:405-733-7300
Practice Address - Fax:405-733-7333
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126440AMedicaid
OK100126440AMedicaid