Provider Demographics
NPI:1609834142
Name:GILCHRIST, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:GILCHRIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3033 NW 63RD ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3634
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-755-2795
Practice Address - Street 1:3824 S BOULEVARD
Practice Address - Street 2:SUITE 160
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5778
Practice Address - Country:US
Practice Address - Phone:405-562-1810
Practice Address - Fax:405-562-1816
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK16187174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100090320 AMedicaid
OK248305101Medicare PIN