Healthcare Provider Details

I. General information

NPI: 1134268139
Provider Name (Legal Business Name): JEREMY T PHELPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 36TH AVE NW STE 150
NORMAN OK
73072-2489
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone: 405-307-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number27908
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: