Provider Demographics
NPI:1407823982
Name:GILBRETH, JUDITH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARIE
Last Name:GILBRETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:GILBRETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2434 HARVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533
Mailing Address - Country:US
Mailing Address - Phone:580-252-1918
Mailing Address - Fax:580-252-2333
Practice Address - Street 1:2434 HARVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:580-252-1918
Practice Address - Fax:580-252-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK232803801OtherMEDICARE PROVIDER NUMBER
OKOK700276OtherMEDICARE INDIVIDUAL PTAN
OK100170200COtherSOONERCARE PROVIDER NUMBE
OK100170200BMedicaid
OK100170200BMedicaid
OK300522104Medicare ID - Type UnspecifiedGROUP NUMBER
OK100170200COtherSOONERCARE PROVIDER NUMBE