Healthcare Provider Details

I. General information

NPI: 1275443830
Provider Name (Legal Business Name): QAIS ISAM ABDUL RAHMAN AL JORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 NE 4TH ST # F419
OKLAHOMA CITY OK
73117-2438
US

IV. Provider business mailing address

1033 NE 4TH ST # F419
OKLAHOMA CITY OK
73117-2438
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50121
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: