Healthcare Provider Details

I. General information

NPI: 1487686200
Provider Name (Legal Business Name): ALFRED D JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12697 E 51ST ST
TULSA OK
74146-6236
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax: 918-505-3225
Mailing address:
  • Phone: 918-505-3200
  • Fax: 918-505-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberL4470
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number058970
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number32593
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: