Provider Demographics
NPI:1740273556
Name:PARMAR, JITENDRA RAVJI (MD)
Entity type:Individual
Prefix:
First Name:JITENDRA
Middle Name:RAVJI
Last Name:PARMAR
Suffix:
Gender:M
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 629
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-0629
Mailing Address - Country:US
Mailing Address - Phone:918-689-2541
Mailing Address - Fax:918-689-7285
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4010
Practice Address - Country:US
Practice Address - Phone:918-689-2541
Practice Address - Fax:918-689-7285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15445207RG0100X
IN32240207RG0100X
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731262066001OtherBLUE CROSS BLUE SHIELD
OK731262066001OtherBLUE CROSS BLUE SHIELD