Individual
JEFFREY DON BIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
225 NE 97TH ST, SUITE 600, OKLAHOMA CITY, OK 73114-6302
(405) 841-7875
Mailing address
14275 MIDWAY ROAD, SUITE 400, ADDISON, TX 75001-3676
(405) 841-7875
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA807
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100156320A
—
OK
Enumeration date
11/17/2006
Last updated
09/26/2017
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