1407823982 NPI number — DR. JUDITH MARIE GILBRETH M.D.

Table of content: DR. JUDITH MARIE GILBRETH M.D. (NPI 1407823982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407823982 NPI number — DR. JUDITH MARIE GILBRETH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBRETH
Provider First Name:
JUDITH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILBRETH
Provider Other First Name:
JUDITH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407823982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2434 HARVILLE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DUNCAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-252-1918
Provider Business Mailing Address Fax Number:
580-252-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2434 HARVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-252-1918
Provider Business Practice Location Address Fax Number:
580-252-2333
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  19187 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 232803801 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: OK700276 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100170200C . This is a "SOONERCARE PROVIDER NUMBE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100170200B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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