Provider Demographics
NPI:1710475645
Name:JENKINS, HAROLD RAY
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:RAY
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BRAGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74423-0335
Mailing Address - Country:US
Mailing Address - Phone:918-577-5552
Mailing Address - Fax:
Practice Address - Street 1:400 MADISON ST.
Practice Address - Street 2:
Practice Address - City:BRAGGS
Practice Address - State:OK
Practice Address - Zip Code:74423
Practice Address - Country:US
Practice Address - Phone:918-577-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist