Provider Demographics
NPI:1114925781
Name:ANDERSON, GAYNELL SCHIEBER (MD)
Entity Type:Individual
Prefix:
First Name:GAYNELL
Middle Name:SCHIEBER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYNELL
Other - Middle Name:MARIE
Other - Last Name:SCHIEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-878-8110
Mailing Address - Fax:405-214-1551
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-878-8110
Practice Address - Fax:405-214-1551
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
89417OtherAETNA
OK100120200AMedicaid
OP033001OtherHUMANA
5723913001OtherCIGNA
OK100120200AMedicaid
5723913001OtherCIGNA