Provider Demographics
NPI:1619068715
Name:LAMBERT, GARY WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5528
Mailing Address - Country:US
Mailing Address - Phone:918-682-1433
Mailing Address - Fax:918-682-4037
Practice Address - Street 1:620 E OKMULGEE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5528
Practice Address - Country:US
Practice Address - Phone:918-682-1433
Practice Address - Fax:918-682-4037
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100111420AMedicaid
E09851Medicare UPIN
OK100111420AMedicaid
E09851Medicare UPIN