Provider Demographics
NPI:1992739932
Name:REMINGTON, JASON DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DEAN
Last Name:REMINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 7TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2302
Mailing Address - Country:US
Mailing Address - Phone:918-367-8818
Mailing Address - Fax:918-367-8820
Practice Address - Street 1:700 W 7TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-8818
Practice Address - Fax:918-367-8820
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200040880AMedicaid
I23864Medicare UPIN
OK200040880AMedicaid