Provider Demographics
NPI:1609899624
Name:DEJARNETT, DEBORAH JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JEAN
Last Name:DEJARNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DBEORAH
Other - Middle Name:JEAN
Other - Last Name:MATTOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10502 N 110TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6655
Mailing Address - Country:US
Mailing Address - Phone:918-376-8971
Mailing Address - Fax:918-376-8549
Practice Address - Street 1:10502 N 110TH E AVE
Practice Address - Street 2:BAILEY MEDICAL CENTER
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6655
Practice Address - Country:US
Practice Address - Phone:918-376-8971
Practice Address - Fax:918-376-8549
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3370207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100117960AMedicaid
G70138Medicare UPIN
OK100117960AMedicaid