Healthcare Provider Details

I. General information

NPI: 1194285197
Provider Name (Legal Business Name): JEFFREY SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

4502 E 41ST ST
TULSA OK
74135-2536
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-4400
  • Fax: 918-660-3132
Mailing address:
  • Phone: 918-660-3511
  • Fax: 918-660-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34731
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number34731
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: