Provider Demographics
NPI:1417291139
Name:ZANDER, JEFFREY ALAN (DPH)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:ZANDER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5258 S. LEWIS AVE.
Mailing Address - Street 2:#1116
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6529
Mailing Address - Country:US
Mailing Address - Phone:918-209-6474
Mailing Address - Fax:
Practice Address - Street 1:201 E. 7TH AVE.
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010
Practice Address - Country:US
Practice Address - Phone:918-367-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist