Basic Information
| Provider Information | |||||||||
| NPI: | 1487686200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12697 E 51ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741466236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185053200 | ||||||||
| FaxNumber: | 9185053225 | ||||||||
| Practice Location | |||||||||
| Address1: | 12697 E 51ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741466236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185053200 | ||||||||
| FaxNumber: | 9185053225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | L4470 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 2086X0206X | 058970 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 207VX0201X | 32593 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200674540A | 05 | OK | MEDICAID | 8DB701 | 01 | TX | BCBS | OTHER | 288841401 | 05 | TX | MEDICAID | 288841402 | 05 | TX | MEDICAID | P01096120 | 01 | TX | RAILROAD MEDICAR | OTHER |