Provider Demographics
NPI:1912951716
Name:CAMERON, JENNIFER RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RENE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:RENE
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1356 E 66TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3843
Mailing Address - Country:US
Mailing Address - Phone:918-289-0005
Mailing Address - Fax:918-289-0697
Practice Address - Street 1:1356 E 66TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3843
Practice Address - Country:US
Practice Address - Phone:918-289-0005
Practice Address - Fax:918-289-0697
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37D2064484OtherCLIA
OKOKB5772OtherPTAN