Provider Demographics
NPI:1518964097
Name:ALEXANDER, JEFF (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6565 S YALE AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8378
Mailing Address - Country:US
Mailing Address - Phone:918-494-8333
Mailing Address - Fax:918-434-8334
Practice Address - Street 1:6565 S YALE AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8378
Practice Address - Country:US
Practice Address - Phone:918-494-8333
Practice Address - Fax:918-434-8334
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11911207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522134Medicare ID - Type Unspecified
OKD38598Medicare UPIN