Provider Demographics
NPI:1154764850
Name:JURY, TONYA RAE (IDC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:RAE
Last Name:JURY
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1003
Mailing Address - Country:US
Mailing Address - Phone:405-582-6654
Mailing Address - Fax:
Practice Address - Street 1:3001 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1003
Practice Address - Country:US
Practice Address - Phone:405-582-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman