Healthcare Provider Details

I. General information

NPI: 1740223403
Provider Name (Legal Business Name): JEANNE M EDWARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717-B S UTICA SUITE 200
TULSA OK
74104
US

IV. Provider business mailing address

1717-B S UTICA SUITE 200
TULSA OK
74104
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-7900
  • Fax: 918-712-9757
Mailing address:
  • Phone: 918-712-7900
  • Fax: 918-712-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13708
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: