Provider Demographics
NPI:1891982625
Name:JENKS HEALTH TEAM, LLC
Entity Type:Organization
Organization Name:JENKS HEALTH TEAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-299-9447
Mailing Address - Street 1:715 W MAIN ST
Mailing Address - Street 2:SUITE S
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3554
Mailing Address - Country:US
Mailing Address - Phone:918-299-9447
Mailing Address - Fax:918-299-5325
Practice Address - Street 1:715 W MAIN ST
Practice Address - Street 2:SUITE S
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3554
Practice Address - Country:US
Practice Address - Phone:918-299-9447
Practice Address - Fax:918-299-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty