Provider Demographics
NPI:1013915701
Name:FINKENSTAEDT, JEFF ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:ROBERT
Last Name:FINKENSTAEDT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 E 31ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1500
Mailing Address - Country:US
Mailing Address - Phone:918-747-8997
Mailing Address - Fax:918-744-8011
Practice Address - Street 1:3540 EAST 31ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1526
Practice Address - Country:US
Practice Address - Phone:918-747-8997
Practice Address - Fax:918-744-8011
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK192213EP1101X, 213ER0200X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100780500AMedicaid
U61468Medicare UPIN