Provider Demographics
NPI:1720785330
Name:KRAVIS, JASON ALAN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:KRAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 S 77TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7739
Mailing Address - Country:US
Mailing Address - Phone:918-934-0194
Mailing Address - Fax:
Practice Address - Street 1:6016 S 66TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9210
Practice Address - Country:US
Practice Address - Phone:918-231-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist