Provider Demographics
NPI:1043205651
Name:SHRECK, GARRICK LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:GARRICK
Middle Name:LEE
Last Name:SHRECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4204
Mailing Address - Country:US
Mailing Address - Phone:405-533-2433
Mailing Address - Fax:405-533-2434
Practice Address - Street 1:1921 W 6TH AVE STE A
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4204
Practice Address - Country:US
Practice Address - Phone:405-533-2433
Practice Address - Fax:833-623-1821
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100107920BMedicaid
OK24429301Medicare ID - Type UnspecifiedMEDICARE
OK100107920BMedicaid