Healthcare Provider Details

I. General information

NPI: 1437129830
Provider Name (Legal Business Name): WILLIAM CLIFF JENNINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 600
TULSA OK
74104-5638
US

IV. Provider business mailing address

PO BOX 268838
OKLAHOMA CITY OK
73126-8838
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3523
  • Fax: 918-744-3463
Mailing address:
  • Phone: 918-660-3632
  • Fax: 918-660-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11514
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: