Provider Demographics
NPI:1336110717
Name:GIN, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:GIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:C
Other - Last Name:GIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLLC
Mailing Address - Street 1:1211 N SHARTEL AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2400
Mailing Address - Country:US
Mailing Address - Phone:405-682-9955
Mailing Address - Fax:405-682-9979
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-682-9955
Practice Address - Fax:405-682-9979
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK114822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100252780BMedicaid
OKP00281427OtherRAILROAD MEDICARE
OKP00281427OtherRAILROAD MEDICARE
OKD34692Medicare UPIN