Provider Demographics
NPI:1285615351
Name:VODA, JAN K (MD)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:K
Last Name:VODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:K
Other - Last Name:VODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:STE 6200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1049
Mailing Address - Country:US
Mailing Address - Phone:405-272-8424
Mailing Address - Fax:405-231-8818
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:STE 6200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1049
Practice Address - Country:US
Practice Address - Phone:405-272-8424
Practice Address - Fax:405-231-8818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14534207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C95624Medicare UPIN