Provider Demographics
NPI:1659372878
Name:CRAVENS, JERE DAVIES (MD)
Entity Type:Individual
Prefix:DR
First Name:JERE
Middle Name:DAVIES
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERE
Other - Middle Name:D
Other - Last Name:CRAVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:715
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7822
Mailing Address - Country:US
Mailing Address - Phone:918-481-4750
Mailing Address - Fax:918-481-4755
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:#715
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7822
Practice Address - Country:US
Practice Address - Phone:918-481-4750
Practice Address - Fax:918-481-4755
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF61068Medicare UPIN