| Organization Name: | JILLIAN RILEY D.O. P.C. |
| NPI Number: | 1376780031 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JILLIAN R RILEY (OWNER) |
| Mailing Address: | 1202 W Cherokee St Suite D Wagoner |
| State: | OK US |
| Postal Code: | 744674629 |
| Phone Number: | 9184062567 |
| Fax Number: | 9187421103 |
| NPI Enumeration Date: | 01/15/2009 |
| NPI Last Update Date: | 06/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 4553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |