Provider Demographics
NPI:1871733519
Name:MJR ENTERPRISES LLC
Entity type:Organization
Organization Name:MJR ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-260-8802
Mailing Address - Street 1:58 ST ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1107
Mailing Address - Country:US
Mailing Address - Phone:918-260-8802
Mailing Address - Fax:918-252-0878
Practice Address - Street 1:3800 W. 71ST
Practice Address - Street 2:INVERNESS VILLAGE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132
Practice Address - Country:US
Practice Address - Phone:918-388-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2299207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty