Basic Information
| Provider Information | |||||||||
| NPI: | 1124167242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEINEN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3110 SW 89TH ST STE 102C | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731597920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057033611 | ||||||||
| FaxNumber: | 4057033711 | ||||||||
| Practice Location | |||||||||
| Address1: | 3110 SW 89TH ST STE 102C | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057033611 | ||||||||
| FaxNumber: | 4057033711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25158 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.