Provider Demographics
NPI:1346200177
Name:DERINGTON, GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:DERINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 S YALE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6711 S YALE AVE
Practice Address - Street 2:STE 202
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3313
Practice Address - Country:US
Practice Address - Phone:918-359-5942
Practice Address - Fax:918-359-5941
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100157510BMedicaid
OKD35079Medicare UPIN