Provider Demographics
NPI:1689843997
Name:GILBRETH FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:GILBRETH FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILBRETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-252-1918
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19187261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100170200COtherMEDICAID/SOONERCARE
OK467450776003OtherBLUE CROSS BLUE SHIELD
OK100170200DOtherMEDICAID/SOONERCARE
OKOKB5213Medicare PIN