MEDICARE: JENNY J ALEXOPULOS DO

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	207Q00000X	Family Medicine Physician	3015	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962470609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY J ALEXOPULOS DO

Provider Business Mailing Address
First Line	:	802 S JACKSON AVE STE 420
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74127-9059
Country	:	US
Telephone Number	:	918-584-5364
Fax Number	:	918-584-5394

Provider Business Practice Location Address
First Line	:	5310 E 31ST ST FL 11
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-5018
Country	:	US
Telephone Number	:	918-584-5364
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/14/2022

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