Provider Demographics
NPI:1376596486
Name:GENGLER, JEFFREY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:GENGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 S 73RD EAST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5448
Mailing Address - Country:US
Mailing Address - Phone:918-408-7351
Mailing Address - Fax:918-764-9994
Practice Address - Street 1:9402 S 73RD EAST PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5448
Practice Address - Country:US
Practice Address - Phone:918-408-7351
Practice Address - Fax:918-764-9994
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24192207L00000X
NC200200223207L00000X
CO42178207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243606701Medicare ID - Type Unspecified
OKI05228Medicare UPIN
COCO307317Medicare PIN