Provider Demographics
NPI:1760444160
Name:HILLMAN, GARY WARREN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WARREN
Last Name:HILLMAN
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 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:4050 W MEMORIAL RD
Practice Address - Street 2:ER DEPT.
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3402
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3957207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846140BMedicaid
OK100846140AMedicaid
OKH07445Medicare UPIN
OK100846140BMedicaid
OK930126929Medicare PIN
OK930126274Medicare PIN
OK248305003Medicare PIN