Provider Demographics
NPI:1982881686
Name:JENNIFER GIBBENS MD PLLC
Entity type:Organization
Organization Name:JENNIFER GIBBENS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIBBENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-712-0220
Mailing Address - Street 1:1805 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4610
Mailing Address - Country:US
Mailing Address - Phone:918-712-0220
Mailing Address - Fax:918-712-0770
Practice Address - Street 1:1805 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-712-0220
Practice Address - Fax:918-712-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty