Provider Demographics
NPI:1346696531
Name:MACINTOSH, JACQUELYN DESIREE (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:DESIREE
Last Name:MACINTOSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELYN
Other - Middle Name:DESIREE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3441 24TH AVE NW STE 105
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6716
Mailing Address - Country:US
Mailing Address - Phone:405-321-2929
Mailing Address - Fax:405-366-8701
Practice Address - Street 1:3441 24TH AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6716
Practice Address - Country:US
Practice Address - Phone:405-321-2929
Practice Address - Fax:405-366-8701
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6144207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty