Provider Demographics
NPI:1194746776
Name:HARJO, JIM B (DO)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:B
Last Name:HARJO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2235 E 61ST ST STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-0102
Practice Address - Country:US
Practice Address - Phone:539-476-9802
Practice Address - Fax:539-476-9804
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200007770AMedicaid
OK200007770AMedicaid
OKOKA100758Medicare PIN