Provider Demographics
NPI:1033181920
Name:CALVERT, JON CHANNING (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CHANNING
Last Name:CALVERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-743-8200
Mailing Address - Fax:918-743-8609
Practice Address - Street 1:7912 E 31ST CT
Practice Address - Street 2:STE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1315
Practice Address - Country:US
Practice Address - Phone:918-743-8200
Practice Address - Fax:918-743-8609
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13932207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100790630DMedicaid
OK249401702Medicare ID - Type Unspecified
OK100790630DMedicaid
OKOKAAA2174Medicare PIN