1003193061 NPI number — GABRIEL M PITMAN DO

Table of content: (NPI 1003193061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003193061 NPI number — GABRIEL M PITMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GABRIEL M PITMAN DO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003193061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 SW 80TH STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73139-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-632-9090
Provider Business Mailing Address Fax Number:
405-632-9097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 SW 80TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73109-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-632-9090
Provider Business Practice Location Address Fax Number:
405-632-9097
Provider Enumeration Date:
11/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PITMAN
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-632-9090

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  4018 , 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: P000722130 . This is a "RAILROAD MEDICARE THRU NSO" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200011220A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200011220B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00066226 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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