Provider Demographics
NPI:1073592945
Name:MCNULTY, GERARD J (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3310
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:6600 S YALE AVE
Practice Address - Street 2:STE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3310
Practice Address - Country:US
Practice Address - Phone:918-481-4944
Practice Address - Fax:918-481-4953
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN
OKF22599Medicare UPIN