Provider Demographics
NPI:1770602526
Name:GARY W LAMBERT, D. O.
Entity type:Organization
Organization Name:GARY W LAMBERT, D. O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:918-682-1433
Mailing Address - Street 1:620 EAST OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:918-682-1433
Mailing Address - Fax:918-682-4037
Practice Address - Street 1:620 EAST OKMULGEE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-682-1433
Practice Address - Fax:918-682-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444507477001OtherBLUE CROSS BLUE SHIELD
OK100737340AMedicaid
OK100111420AMedicaid
OK444507477Medicare ID - Type Unspecified
OKLAMBGWMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OK100737340AMedicaid