Gregory Y Jia MD Inc PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

19082 Issued in OK

Legal business name

GREGORY Y JIA MD INC PC

Practice address

908 19TH St
Suite 300
Woodward, OK 73801-2307

Phone

(580) 256-7377

Fax

(580) 256-7767

NPI assigned

Feb 8, 2007

Last updated

Oct 21, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary X Jia

Title

Office Manager

Phone

(580) 256-7377

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1851431506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 19TH ST",
            "address_2": "SUITE 300",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738012307",
            "telephone_number": "580-256-7377",
            "fax_number": "580-256-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 19TH ST",
            "address_2": "SUITE 300",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738012307",
            "telephone_number": "580-256-7377",
            "fax_number": "580-256-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY Y JIA MD INC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "JIA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "X",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-256-7377",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OK",
            "license": "19082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100138540A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.