Provider Demographics
NPI:1316972813
Name:COLDIRON, JO ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:COLDIRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JO
Other - Middle Name:ELLEN
Other - Last Name:MEISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74602-2005
Mailing Address - Country:US
Mailing Address - Phone:580-765-0673
Mailing Address - Fax:
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:STE 50 OUTPATIENT SURGICAL CTR
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1920
Practice Address - Country:US
Practice Address - Phone:580-765-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14761207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D34518Medicare UPIN