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Dezjuan Vonte Jackson
Prosthetic/Orthotic Supplier in Oklahoma City, Oklahoma
NPI 1679073183

Dezjuan Vonte Jackson is a Prosthetic/Orthotic Supplier based in Oklahoma City, OK. Dezjuan Vonte Jackson practices in Oklahoma City, OK. The NPI Number for Dezjuan Vonte Jackson is 1679073183 and holds a License No. (Oklahoma).

The current practice location address for Dezjuan Vonte Jackson is 10461 N May Ave, Oklahoma City, OK and can be reached out via phone at 405-543-6314.

Location: 10461 N May Ave, Oklahoma City, OK, 73120-2610
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679073183
Provider Name
Dezjuan Vonte Jackson
Credential
Provider Entity Type
Individual
Gender
Male
Address
10461 N May Ave, Oklahoma City, OK, 73120-2610
Phone Number
405-543-6314
Fax Number
Provider Enumeration Date
02/20/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
10461 N May Ave
City
Oklahoma City
State
Oklahoma
Zip
73120-2610
Phone Number
405-543-6314
Fax Number
person
Provider Business Mailing Address Details
Address
10461 N May Ave
City
Oklahoma City
State
Oklahoma
Zip
73120-2610
Phone Number
405-543-6314
Fax Number
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Durable Medical Equipment & Medical Supplies
Speciality
-
Taxonomy
332B00000X
License No.
314007 (Oklahoma)
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
()
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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