Provider Demographics
NPI:1093934531
Name:JEFFY, ELON RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELON
Middle Name:RUSSELL
Last Name:JEFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2436 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 S BALTIMORE AVE STE 202
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5215
Practice Address - Country:US
Practice Address - Phone:918-644-0141
Practice Address - Fax:918-392-4741
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218356208000000X, 2084P0804X
OK262842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics