Doctor Name: | MRS. JAZMIN MATLOCK BAKER |
NPI Number: | 1124312004 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 3150 |
Business Practice Address: | 100 S Bliss Ave Tahlequah, OK - 744642512 |
Business Phone Number: | 9184587105 |
Business Fax Number: | |
Mailing Address: | 2507 Cambridge Cir, TAHLEQUAH |
State: | OK |
Postal Code: | 744644689 |
Phone Number: | 9186050247 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2011 |
NPI Last Update Date: | 04/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VX0000X |
License Number: | 3150 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Obstetrics |
Taxonomy Definition: |