Provider Demographics
NPI:1407883804
Name:JONES, PETE (MD MSPH)
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MD MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 703024
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-3024
Mailing Address - Country:US
Mailing Address - Phone:918-425-8600
Mailing Address - Fax:918-425-3305
Practice Address - Street 1:529 E 36TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1812
Practice Address - Country:US
Practice Address - Phone:918-425-8600
Practice Address - Fax:918-425-3305
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100154200BMedicaid
OK100154200BMedicaid