Provider Demographics
NPI:1033221403
Name:PITMAN, GABRIEL MARSH (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MARSH
Last Name:PITMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GABE
Other - Middle Name:
Other - Last Name:PITMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:401 SW 80TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139
Mailing Address - Country:US
Mailing Address - Phone:405-632-9090
Mailing Address - Fax:405-632-9097
Practice Address - Street 1:401 SW 80
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-632-9090
Practice Address - Fax:405-632-9097
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00722130OtherRAILROAD MCARE THRU NSO
OK200011220BMedicaid
OK200011220AMedicaid
OKP00066226OtherRAILROAD MEDICARE
OKP00722130OtherRAILROAD MCARE THRU NSO
OK232712401Medicare PIN