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General NPI Number Information
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NPI Number | 1093934531
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Entity Type | Individual
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Provider Name | ELON RUSSELL JEFFY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 1811 S BALTIMORE AVE STE 202
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City | TULSA
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State | OK
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Zip | 74119-5215
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Country | US
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Telephone | 918-644-0141
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Fax | 918-392-4741
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Provider Business Mailing Address
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Address Line | 2436 E 23RD ST
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City | TULSA
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State | OK
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Zip | 74114-3115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 218356
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 218356
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 26284
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License Number State | OK
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