Provider Demographics
NPI:1043352198
Name:BIERACH, JENNIFER BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:BIERACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BETH
Other - Last Name:QUAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1245 S UTICA AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-382-2560
Mailing Address - Fax:918-382-2569
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-382-6540
Practice Address - Fax:918-382-2569
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24675207R00000X
WI53266-20207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200176290AMedicaid
OK269397YLV0Medicare PIN