Provider Demographics
NPI:1295735355
Name:JONES, JEFFREY R (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-213-9012
Mailing Address - Fax:580-213-9795
Practice Address - Street 1:2821 N VAN BUREN ST STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1729
Practice Address - Country:US
Practice Address - Phone:580-213-9012
Practice Address - Fax:580-213-9795
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100176940AMedicaid
OKP00069156OtherRAILROAD
OK241412214Medicare PIN
E09730Medicare UPIN
OKOK700707Medicare PIN