Healthcare Provider Details

I. General information

NPI: 1083809479
Provider Name (Legal Business Name): GERBER FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W KANSAS
OKARCHE OK
73762
US

IV. Provider business mailing address

PO BOX 129
OKARCHE OK
73762-0129
US

V. Phone/Fax

Practice location:
  • Phone: 405-263-7263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11794
License Number StateOK

VIII. Authorized Official

Name: DARLENE OSTERHOLT
Title or Position: BILLING ADMIN
Credential:
Phone: 405-263-4666