MEDICARE: DR. JEFFERY JAMES BLONSKY M.D.

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	207RG0100X	Gastroenterology Physician	04-31177	KS
2	207RG0100X	Gastroenterology Physician	11673	ND
3	207RG0100X	Gastroenterology Physician	30250	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609896596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY JAMES BLONSKY M.D.

Provider Business Mailing Address
First Line	:	6465 S YALE AVE STE 1002
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7812
Country	:	US
Telephone Number	:	918-481-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	10507 E 91ST ST # 270
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5589
Country	:	US
Telephone Number	:	918-307-5480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/11/2014

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Directions to “ DR. JEFFERY JAMES BLONSKY M.D.” Practice Location

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