Provider Demographics
NPI:1750496659
Name:SCOUFOS, JENNIFER C (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:SCOUFOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-6867
Mailing Address - Country:US
Mailing Address - Phone:918-774-0147
Mailing Address - Fax:918-774-0286
Practice Address - Street 1:555 W RUTH AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-6867
Practice Address - Country:US
Practice Address - Phone:918-774-0147
Practice Address - Fax:918-774-0286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine