MEDICARE: HARVEY C JENKINS PH D M D PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21473	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	37D1102406	OTHER	OK	CLIA LABORATORY

General Provider Information

NPI Number	:	1245411727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEY C JENKINS PH D M D PLLC

Provider Business Mailing Address
First Line	:	8603 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9200
Country	:	US
Telephone Number	:	405-686-1700
Fax Number	:	405-686-1555

Provider Business Practice Location Address
First Line	:	8603 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9200
Country	:	US
Telephone Number	:	405-686-1700
Fax Number	:	405-686-1555

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MISS TASHONDA RENEE DIXON
Credential	:
Telephone Number	:	405-686-1700

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	08/21/2012

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