Basic Information
| Provider Information | |||||||||
| NPI: | 1144278037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEBHARDT | ||||||||
| FirstName: | GARREN | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 E 31ST ST FL 13 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741355018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185615701 | ||||||||
| FaxNumber: | 9185611173 | ||||||||
| Practice Location | |||||||||
| Address1: | 2345 SOUTHWEST BLVD | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741072705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185611131 | ||||||||
| FaxNumber: | 9185611140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204C00000X | 02003217A | IN | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | 204D00000X | 7091 | OK | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | 7365329 | 01 | IN | AETNA | OTHER | 030371536 | 01 | VT | CIGNA PPO | OTHER | PO1457038 | 01 | IN | RAIL ROAD PTAN | OTHER | 1I4071 | 01 | OK | MEDICARE | OTHER | 200939790A | 05 | OK | MEDICAID | 000000552067 | 01 | IN | ANTHEM | OTHER | 093299 | 01 | IN | SIHO | OTHER | 201269220 | 05 | IN | MEDICAID | 6961878 | 01 | VT | CIGNA HMO | OTHER | 49712 | 01 | VT | BLUE CROSS/BLUE SHIELD | OTHER |