Provider Demographics
NPI:1902396294
Name:MARCHANT, GAIL RENEE
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:RENEE
Last Name:MARCHANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8784 E 105TH CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7063
Mailing Address - Country:US
Mailing Address - Phone:918-369-2396
Mailing Address - Fax:
Practice Address - Street 1:8784 E 105TH CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7063
Practice Address - Country:US
Practice Address - Phone:918-369-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice