Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Broken Arrow Diagnostic Medicine, PLLC

Organization Family Medicine Physician · NPI 1710322672

Broken Arrow Diagnostic Medicine, PLLC is a Family Medicine Physician in Broken Arrow, Oklahoma. Licensed in Oklahoma. Registered with an NPI since 2013.

Licensed in
OK
In the registry since
2013
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5050 E Kenosha St
Broken Arrow, OK 74014-6711
Phone: (918) 994-5140
Fax: (918) 994-5150
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X (OK)

Record details

NPI number1710322672
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jacob Callison — Managing Member · (918) 994-5140
NPI enumeratedMay 6, 2013
Last updated in NPPESOctober 8, 2024
Certification dateOctober 8, 2024
Mailing address5050 E Kenosha St, Broken Arrow, OK 74014-6711

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