Provider Demographics
NPI:1639224264
Name:BENTON, JAMI LUANN (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LUANN
Last Name:BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-242-4300
Mailing Address - Fax:580-242-4306
Practice Address - Street 1:915 E GARRIOTT RD STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6153
Practice Address - Country:US
Practice Address - Phone:580-242-4300
Practice Address - Fax:580-242-4306
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK24348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20165160AMedicaid
OK20165160AMedicaid