Provider Demographics
NPI:1699719773
Name:KLABZUBA, JEANIE L (DO)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:L
Last Name:KLABZUBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5201 W MEMORIAL ROAD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2004
Mailing Address - Country:US
Mailing Address - Phone:405-755-4050
Mailing Address - Fax:405-749-9566
Practice Address - Street 1:5201 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2016
Practice Address - Country:US
Practice Address - Phone:405-755-4050
Practice Address - Fax:405-752-1553
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200070030AMedicaid
OK33605OtherOBNDD
OK4229OtherLICENSE
OKI46836Medicare UPIN
OK33605OtherOBNDD