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General NPI Number Information
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NPI Number | 1104830090
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Entity Type | Organization
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Legal Business Name | GILCREASE MEDICAL CENTER PC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 7125 S. BRADEN AVE.
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-481-8100
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Fax | 918-481-8195
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Provider Business Mailing Address
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Address Line | 7125 S. BRADEN AVE.
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-481-8100
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Fax | 918-481-8195
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY ROBERT LEE
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Credential | M.D.
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Telephone | 918-381-6326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 16665
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 16665
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16665
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License Number State | OK
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