Provider Demographics
NPI:1750424404
Name:LOPER, JEANIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:MARIE
Last Name:LOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:MARIE
Other - Last Name:KILIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5721 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4437
Mailing Address - Country:US
Mailing Address - Phone:405-557-1200
Mailing Address - Fax:405-557-1977
Practice Address - Street 1:5721 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4437
Practice Address - Country:US
Practice Address - Phone:405-557-1200
Practice Address - Fax:405-557-1977
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200173750AMedicaid