Healthcare Provider Details

I. General information

NPI: 1356332886
Provider Name (Legal Business Name): JEFF S. JENNINGS, DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CHEROKEE ST
WAGONER OK
74467-4624
US

IV. Provider business mailing address

4500 S GARNETT RD 300
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-5514
  • Fax: 918-485-9701
Mailing address:
  • Phone: 918-664-9892
  • Fax: 918-664-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF S JENNINGS
Title or Position: OWNER
Credential: DO
Phone: 918-687-6335