MEDICARE: JEFF LOFTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1609547496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF LOFTIS

Provider Business Mailing Address
First Line	:	2413 NW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 NW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-3221
Country	:	US
Telephone Number	:	405-885-9498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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Directions to “ JEFF LOFTIS ” Practice Location

Language	Start Address	Practice Location

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