Provider Demographics
NPI:1922204536
Name:JENNINGS, DAVID CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7107 S YALE AVE
Mailing Address - Street 2:PMB 187
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6308
Mailing Address - Country:US
Mailing Address - Phone:918-615-6581
Mailing Address - Fax:918-893-1242
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:4TH FLOOR REHABILITATION UNIT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-615-6581
Practice Address - Fax:918-893-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4593208100000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200199810AMedicaid
OK200199810AMedicaid