Provider Demographics
NPI:1386744761
Name:RENFROE, JERRY D (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:RENFROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3435 NW 56
Mailing Address - Street 2:#711A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-945-4222
Mailing Address - Fax:405-945-4322
Practice Address - Street 1:3435 NW 56
Practice Address - Street 2:#711A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-945-4222
Practice Address - Fax:405-945-4322
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK8729207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100187980AMedicaid
040004091OtherRR MEDICARE
040004091OtherRR MEDICARE
OKOK400724Medicare PIN