Provider Demographics
NPI:1902126188
Name:DECK, JASON W (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:DECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 S SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5440
Mailing Address - Country:US
Mailing Address - Phone:918-629-6207
Mailing Address - Fax:918-619-4696
Practice Address - Street 1:1111 S SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5440
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4696
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK27889207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine