Healthcare Provider Details

I. General information

NPI: 1962412999
Provider Name (Legal Business Name): TERRY MICHAEL GILE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 S 103RD EAST AVE STE 100
TULSA OK
74146-2445
US

IV. Provider business mailing address

3840 S 103RD EAST AVE STE 100
TULSA OK
74146-2445
US

V. Phone/Fax

Practice location:
  • Phone: 918-921-9700
  • Fax: 918-292-8263
Mailing address:
  • Phone: 918-921-9700
  • Fax: 918-292-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2276
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2276
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: