Provider Demographics
NPI:1780703900
Name:JANSEN, JEREMIAH A (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:A
Last Name:JANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-945-4710
Mailing Address - Fax:405-562-9242
Practice Address - Street 1:3330 NW 56TH
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-945-4710
Practice Address - Fax:405-562-9242
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NETEP5419207R00000X
NJ25MA113376002085R0202X
OK258572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2000292930AMedicaid
OKP00964011OtherMEDICARE RAILROAD
OKP00964011OtherMEDICARE RAILROAD