Provider Demographics
NPI:1326275967
Name:BEDFORD, JEFFREY DAVIS (BA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVIS
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1404
Mailing Address - Country:US
Mailing Address - Phone:918-423-6030
Mailing Address - Fax:918-423-2370
Practice Address - Street 1:1151 NORTH HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:STRINGTON
Practice Address - State:OK
Practice Address - Zip Code:74569
Practice Address - Country:US
Practice Address - Phone:580-346-7301
Practice Address - Fax:580-346-7214
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)