Basic Information
| Provider Information | |||||||||
| NPI: | 1447390927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOLLIFF | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 NW EXPRESSWAY STE 610 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731127251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052869465 | ||||||||
| FaxNumber: | 4052869462 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 SW 80TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731398123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056015169 | ||||||||
| FaxNumber: | 4056019095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 23996 | OK | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.