Provider Demographics
NPI:1487686200
Name:JENKINS, ALFRED D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:D
Last Name:JENKINS
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 1:12697 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6236
Mailing Address - Country:US
Mailing Address - Phone:918-505-3200
Mailing Address - Fax:918-505-3225
Practice Address - Street 1:12697 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-6236
Practice Address - Country:US
Practice Address - Phone:918-505-3200
Practice Address - Fax:918-505-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4470207VX0201X
GA0589702086X0206X
OK32593207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200674540AMedicaid
TX8DB701OtherBCBS
TX288841401Medicaid
TX288841402Medicaid
TXP01096120OtherRAILROAD MEDICAR
OK365304ZSS0Medicare UPIN
TX8DB701OtherBCBS
TXTXB145474Medicare UPIN
TXTXB146478Medicare PIN
TX8DB701OtherBCBS
FLBJ5436440OtherDEA
TXTXB145474Medicare UPIN
FL2701360800Medicaid