Provider Demographics
NPI:1669770145
Name:TRAD, JAWAD (DO)
Entity type:Individual
Prefix:DR
First Name:JAWAD
Middle Name:
Last Name:TRAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:T.J.
Other - Middle Name:
Other - Last Name:TRAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2100 S UTICA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1437
Mailing Address - Country:US
Mailing Address - Phone:918-932-3836
Mailing Address - Fax:918-203-0027
Practice Address - Street 1:2100 S UTICA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1437
Practice Address - Country:US
Practice Address - Phone:918-932-3836
Practice Address - Fax:918-203-0027
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5126207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200469330BMedicaid