Provider Demographics
NPI:1558516112
Name:GREGG S GOVETT, M.D., P.C.
Entity Type:Organization
Organization Name:GREGG S GOVETT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:GOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-732-3755
Mailing Address - Street 1:1205 S AIR DEPOT BLVD
Mailing Address - Street 2:PMB 131
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4807
Mailing Address - Country:US
Mailing Address - Phone:405-732-3755
Mailing Address - Fax:405-733-1784
Practice Address - Street 1:1201 S POST ROAD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-732-3755
Practice Address - Fax:405-733-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5283Medicare PIN