MEDICARE: GERALD W. MCCULLOUGH, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	6711	OK

General Provider Information

NPI Number	:	1033242995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD W. MCCULLOUGH, M.D., INC.

Provider Business Mailing Address
First Line	:	900 N PORTER AVE STE 107
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-6426
Country	:	US
Telephone Number	:	405-329-2442
Fax Number	:	405-329-5149

Provider Business Practice Location Address
First Line	:	900 N PORTER AVE STE 107
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-6426
Country	:	US
Telephone Number	:	405-329-2442
Fax Number	:	405-329-5149

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERALD WILLIAM MCCULLOUGH
Credential	:	M.D., F.A.C.S.
Telephone Number	:	405-329-2442

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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