JEREMY THEISEN MD
Individual Provider (NPI-1)
Active
Radiology, Diagnostic Radiology
Provider Information
- NPI Number
1881954501- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 1900 N 14TH ST, PONCA CITY, OK, 746012035
- Phone
- (580) 765-0575
Specialties & Taxonomies
Radiology, Diagnostic Radiology
License: HI #MD-23144
Internal Medicine
License: OK #29296
Radiology, Diagnostic Radiology
Primary License: OK #29296
Radiology, Diagnostic Radiology
License: NJ #25IA12501900