Healthcare Provider Details

I. General information

NPI: 1447379987
Provider Name (Legal Business Name): JERROLD BENEDICT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 N SHERIDAN RD
TULSA OK
74115-4610
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD SUITE 300
FRANKLIN TN
37067-2626
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-4066
  • Fax: 615-778-9114
Mailing address:
  • Phone: 615-778-4066
  • Fax: 615-778-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number332149
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH4163
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17441
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17441
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17441
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE-15344
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: