Provider Demographics
NPI:1841628278
Name:DOH, GILBERT (MS)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:DOH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 W LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4188
Mailing Address - Country:US
Mailing Address - Phone:405-416-4336
Mailing Address - Fax:
Practice Address - Street 1:628 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4814
Practice Address - Country:US
Practice Address - Phone:405-626-1711
Practice Address - Fax:405-895-7544
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200347950AMedicaid