Provider Demographics
NPI:1609896596
Name:BLONSKY, JEFFERY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JAMES
Last Name:BLONSKY
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 1:6465 S YALE AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7812
Mailing Address - Country:US
Mailing Address - Phone:918-481-4700
Mailing Address - Fax:
Practice Address - Street 1:10507 E 91ST ST # 270
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5589
Practice Address - Country:US
Practice Address - Phone:918-307-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31177207RG0100X
ND11673207RG0100X
OK30250207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200536180AMedicaid
ND15750Medicaid
NDN715517Medicare PIN
ND15750Medicaid
OK350100ZGR7Medicare PIN