Jerry Medlock

NPI #1285164392 in Del City, Oklahoma

Provider Information

NPI Number: 1285164392
Entity Type: Individual
Name: Jerry Medlock
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Jun 13, 2017
Last Updated: Jul 21, 2022

Practice Location

Address: 4312 VFW DR. APT # 7
Address 2: 4312 VFW DR. APT # 7
City: Del City
State: Oklahoma
ZIP Code: 73115
Phone: (405) 468-0922

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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