Healthcare Provider Details

I. General information

NPI: 1538839154
Provider Name (Legal Business Name): GREGORY DON BALCERAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 6TH AVE
STILLWATER OK
74074-4202
US

IV. Provider business mailing address

501 COPPERFIELD DR
EDMOND OK
73003-6177
US

V. Phone/Fax

Practice location:
  • Phone: 405-743-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8596
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: