Provider Demographics
NPI:1013996164
Name:OFFERMANN, GAIL LYNN (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:LYNN
Last Name:OFFERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N. FOREMAN
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1422
Mailing Address - Country:US
Mailing Address - Phone:918-256-7551
Mailing Address - Fax:918-256-7355
Practice Address - Street 1:735 N. FOREMAN
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1422
Practice Address - Country:US
Practice Address - Phone:918-256-7551
Practice Address - Fax:918-256-7355
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100084060EMedicaid
OK200059690AMedicaid
KS200369750AMedicaid
MO206243800Medicaid
OK100084060AMedicaid
P00257963Medicare PIN
E08030Medicare UPIN
OK100084060EMedicaid
MO206243800Medicaid
KS200369750AMedicaid
DD8330Medicare PIN