Provider Demographics
NPI:1942409990
Name:GANGA M PUJARI
Entity Type:Organization
Organization Name:GANGA M PUJARI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-736-0055
Mailing Address - Street 1:6908 E RENO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-2120
Mailing Address - Country:US
Mailing Address - Phone:405-736-0055
Mailing Address - Fax:405-736-6311
Practice Address - Street 1:6908 E RENO AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2120
Practice Address - Country:US
Practice Address - Phone:405-736-0055
Practice Address - Fax:405-736-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1003590AMedicaid