Provider Demographics
NPI:1417922709
Name:JENKINS, JEFFERY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1401WEST LOCUST
Mailing Address - Street 2:STE 102
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3217
Mailing Address - Country:US
Mailing Address - Phone:918-696-4065
Mailing Address - Fax:918-696-5971
Practice Address - Street 1:1401WEST LOCUST
Practice Address - Street 2:STE 102
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3217
Practice Address - Country:US
Practice Address - Phone:918-696-4065
Practice Address - Fax:918-696-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$TMedicare PIN
OKG53941Medicare UPIN