Provider Demographics
NPI:1528194826
Name:OKA, JEFFERY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RAY
Last Name:OKA
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 1:425 MEDICAL DR
Mailing Address - Street 2:108
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-292-2500
Mailing Address - Fax:801-292-2423
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:108
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-292-2500
Practice Address - Fax:801-292-2423
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1774451205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000010590Medicare PIN