Basic Information
Provider Information | |||||||||
NPI: | 1114925781 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHIEBER ANDERSON | ||||||||
FirstName: | GAYNELL | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SCHIEBER | ||||||||
OtherFirstName: | GAYNELL | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1102 W MACARTHUR ST | ||||||||
Address2: |   | ||||||||
City: | SHAWNEE | ||||||||
State: | OK | ||||||||
PostalCode: | 748041743 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4058788110 | ||||||||
FaxNumber: | 4052141551 | ||||||||
Practice Location | |||||||||
Address1: | 1102 W MACARTHUR ST | ||||||||
Address2: |   | ||||||||
City: | SHAWNEE | ||||||||
State: | OK | ||||||||
PostalCode: | 748041743 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4058788110 | ||||||||
FaxNumber: | 4052141551 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2005 | ||||||||
LastUpdateDate: | 01/03/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21160 | OK | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 100120200A | 05 | OK |   | MEDICAID | OP033001 | 01 |   | HUMANA | OTHER | 5723913001 | 01 |   | CIGNA | OTHER | 89417 | 01 |   | AETNA | OTHER |