Healthcare Provider Details

I. General information

NPI: 1205010600
Provider Name (Legal Business Name): JEFFREY WAYNE GERSTEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date: 11/17/2025
Reactivation Date: 12/03/2025

III. Provider practice location address

4500 S GARNETT RD STE 300
TULSA OK
74146-5238
US

IV. Provider business mailing address

4500 S GARNETT RD STE 300
TULSA OK
74146-5238
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-3550
  • Fax:
Mailing address:
  • Phone: 918-935-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7162
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC2851
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOP61576409
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC2-0024877
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number230723
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MB06425900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: