1588681126 NPI number — DR. GERALD D RANA II D.O.

Table of content: DR. GERALD D RANA II D.O. (NPI 1588681126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588681126 NPI number — DR. GERALD D RANA II D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANA
Provider First Name:
GERALD
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1588681126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 HIGHWAY 2 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILBURTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74578-3625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-465-0170
Provider Business Mailing Address Fax Number:
918-465-4830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 HIGHWAY 2 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBURTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74578-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-465-0170
Provider Business Practice Location Address Fax Number:
918-465-4830
Provider Enumeration Date:
07/17/2006

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:  3417 , 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: 200074810A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200925590I , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100214030E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100214030F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100214030G . This is a "SOONERCARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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