Provider Demographics
NPI:1982660981
Name:JEFFERSON, CHRISTINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:M
Last Name:JEFFERSON
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:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:OK
Mailing Address - Zip Code:74026-0654
Mailing Address - Country:US
Mailing Address - Phone:918-377-2239
Mailing Address - Fax:918-377-2236
Practice Address - Street 1:202 BROADWAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:OK
Practice Address - Zip Code:74026
Practice Address - Country:US
Practice Address - Phone:918-377-2239
Practice Address - Fax:918-377-2236
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100076460AMedicaid
AR102241001Medicaid
AR52651Medicare PIN
ARD04671Medicare UPIN