Provider Demographics
NPI:1649350158
Name:DIEL, GREGORY G (DPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:DIEL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 E OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6156
Mailing Address - Country:US
Mailing Address - Phone:580-233-4244
Mailing Address - Fax:580-233-5319
Practice Address - Street 1:915 E OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-233-4244
Practice Address - Fax:580-233-5319
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
OK10671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator