Provider Demographics
NPI:1154500403
Name:JUDITH M. GILBRETH
Entity Type:Organization
Organization Name:JUDITH M. GILBRETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILBRETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-252-1918
Mailing Address - Street 1:1330 N HARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1514
Mailing Address - Country:US
Mailing Address - Phone:580-252-1918
Mailing Address - Fax:580-252-2333
Practice Address - Street 1:1330 N HARVILLE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1514
Practice Address - Country:US
Practice Address - Phone:580-252-1918
Practice Address - Fax:580-252-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK19187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty