Healthcare Provider Details

I. General information

NPI: 1326029299
Provider Name (Legal Business Name): GEMINI J BOGIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5622 N PORTLAND AVE STE 200
OKLAHOMA CITY OK
73112-2000
US

IV. Provider business mailing address

PO BOX 258881-8881 SECTION# 141
OKLAHOMA CITY OK
73125
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-8193
  • Fax: 405-528-0626
Mailing address:
  • Phone: 405-418-4800
  • Fax: 405-418-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20219
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: