Provider Demographics
NPI:1124060199
Name:JENKINS, HARVEY CLARKE JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:CLARKE
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9200
Mailing Address - Country:US
Mailing Address - Phone:405-686-1700
Mailing Address - Fax:405-686-1555
Practice Address - Street 1:8603 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9200
Practice Address - Country:US
Practice Address - Phone:405-686-1700
Practice Address - Fax:405-686-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21473207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37D1102406OtherCLIA WAIVED LABORATORY ID
OK100034590AMedicaid
OK175793900OtherDEPARTMENT OF LABOR
OK731620950OtherTAX ID #
OK200043654OtherRAILROAD MEDICARE
OK37D1102406OtherCLIA WAIVED LABORATORY ID
OK731620950OtherTAX ID #
OK37D1102406OtherCLIA WAIVED LABORATORY ID