Basic Information
| Provider Information | |||||||||
| NPI: | 1013996164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OFFERMANN | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 735 N. FOREMAN | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182567551 | ||||||||
| FaxNumber: | 9182567355 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 N. FOREMAN | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182567551 | ||||||||
| FaxNumber: | 9182567355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 16103 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100084060E | 05 | OK | MEDICAID | 200059690A | 05 | OK | MEDICAID | 200369750A | 05 | KS | MEDICAID | 206243800 | 05 | MO | MEDICAID | 100084060A | 05 | OK | MEDICAID |