Grand Prairie Pediatric and Allergy Clinic
NPI #1588716104 in Warr Acres, Oklahoma
Provider Information
- NPI Number
- 1588716104
- Entity Type
- Organization
- Organization Name
- Grand Prairie Pediatric and Allergy Clinic
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Jan 16, 2007
- Last Updated
- Jul 21, 2022
Practice Location
- Address
- 7301 N COMANCHE AVE
- City
- Warr Acres
- State
- Oklahoma
- ZIP Code
- 73132-6646
- Phone
- (405) 721-8090
Authorized Official
- Name
- DR. KENNETH C JACKSON, MD
- Title
- PRESIDENT
- Phone
- (405) 721-8090
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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