Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 02003217A | IN |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 7091 | OK |
NPI | 1144278037 |
---|---|
Provider Name | Garren P. Gebhardt |
First Address | Tulsa, OK 74135-5018 |
Second Address | Tulsa, OK 74107-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000552067 | ANTHEM (01) | IN |
030371536 | CIGNA PPO (01) | VT |
093299 | SIHO (01) | IN |
1I4071 | MEDICARE (01) | OK |
200939790A | (05) | OK |
201269220 | (05) | IN |
49712 | BLUE CROSS/BLUE SHIELD (01) | VT |
6961878 | CIGNA HMO (01) | VT |
7365329 | AETNA (01) | IN |
H19450 | (02) | VT |
PO1457038 | RAIL ROAD PTAN (01) | IN |