Provider Demographics
NPI:1609853175
Name:GEARHART, JOHN KELLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLEY
Last Name:GEARHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6528 E 101ST ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6724
Mailing Address - Country:US
Mailing Address - Phone:918-392-5588
Mailing Address - Fax:918-392-5597
Practice Address - Street 1:6528 E 101ST ST
Practice Address - Street 2:STE I
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6724
Practice Address - Country:US
Practice Address - Phone:918-392-5588
Practice Address - Fax:918-392-5597
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK10175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106190AMedicaid
OK100106190AMedicaid
OKOKAAA2129Medicare PIN
OK800522535OtherMEDICARE GROUP PIN