Provider Demographics
NPI:1417988957
Name:HIRSCH, JEFFREY G (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-9052
Mailing Address - Country:US
Mailing Address - Phone:405-815-5060
Mailing Address - Fax:405-815-5065
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-9024
Practice Address - Country:US
Practice Address - Phone:405-815-5060
Practice Address - Fax:405-815-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK10915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249631006Medicare PIN
OKE20590Medicare UPIN