Provider Demographics
NPI:1124279328
Name:WILLIAMS, JEFFREY MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1501 N FLORENCE
Mailing Address - Street 2:STE 101
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3169
Mailing Address - Country:US
Mailing Address - Phone:918-342-3633
Mailing Address - Fax:918-342-8959
Practice Address - Street 1:1501 N FLORENCE
Practice Address - Street 2:101
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-342-3633
Practice Address - Fax:918-342-8959
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200216080AMedicaid
OK200216080AMedicaid