Provider Demographics
NPI:1962470609
Name:ALEXOPULOS, JENNY J (DO)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:J
Last Name:ALEXOPULOS
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 1:802 S JACKSON AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9059
Mailing Address - Country:US
Mailing Address - Phone:918-584-5364
Mailing Address - Fax:918-584-5394
Practice Address - Street 1:5310 E 31ST ST FL 11
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5018
Practice Address - Country:US
Practice Address - Phone:918-584-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100182520DMedicaid
OKG03648Medicare UPIN
OK100182520DMedicaid