Provider Demographics
NPI:1922181593
Name:GILL, RAJI M (DO)
Entity Type:Individual
Prefix:DR
First Name:RAJI
Middle Name:M
Last Name:GILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RAJINDER
Other - Middle Name:S
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1500 EAST DOWNING SUITE 100
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-458-5700
Mailing Address - Fax:918-458-5790
Practice Address - Street 1:1500 EAST DOWNING
Practice Address - Street 2:SUITE 100
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-458-5700
Practice Address - Fax:918-458-5790
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3753208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125770AMedicaid
604532300OtherDEPT OF LABOR
H25691Medicare UPIN