Provider Demographics
NPI:1194791608
Name:CALAVA, JEFFREY M (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:CALAVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1827
Mailing Address - Country:US
Mailing Address - Phone:918-481-6494
Mailing Address - Fax:918-481-6726
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:STE 250
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1827
Practice Address - Country:US
Practice Address - Phone:918-481-6494
Practice Address - Fax:918-481-6726
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2008-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK3179207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10176380AMedicaid
OK10176380AMedicaid
OK10176380AMedicaid