Provider Demographics
NPI:1770680423
Name:GIST, JOEL K (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:K
Last Name:GIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6425 S OSWEGO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1512
Mailing Address - Country:US
Mailing Address - Phone:918-496-1789
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7620
Practice Address - Fax:918-748-7647
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK82492080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine