Provider Demographics
NPI:1144392804
Name:JENNINGS, GEORGE M (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4036
Mailing Address - Country:US
Mailing Address - Phone:918-284-6958
Mailing Address - Fax:918-759-9989
Practice Address - Street 1:211 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4036
Practice Address - Country:US
Practice Address - Phone:918-284-6958
Practice Address - Fax:918-759-9989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112190AMedicaid
OK100112190AMedicaid
OK44456192OKMedicare Oscar/Certification