Provider Demographics
NPI:1518927664
Name:DONEY, JACK R (MD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:R
Last Name:DONEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 2ND AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6702
Mailing Address - Country:US
Mailing Address - Phone:918-542-8477
Mailing Address - Fax:918-542-6422
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6702
Practice Address - Country:US
Practice Address - Phone:918-542-8477
Practice Address - Fax:918-542-6422
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2023-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO11653207QA0505X
OK11653207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1518927664Medicare Oscar/Certification
OKD34587Medicare UPIN