Provider Demographics
NPI:1740223403
Name:EDWARDS, JEANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717-B S UTICA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-712-7900
Mailing Address - Fax:918-712-9757
Practice Address - Street 1:1717-B S UTICA
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-712-7900
Practice Address - Fax:918-712-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100048960BMedicaid
OKD34606Medicare UPIN
OK100048960BMedicaid