MEDICARE: DR. GARY WAYNE RAHE M.D.

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	207RH0003X	Hematology & Oncology Physician	8469	OK

General Provider Information

NPI Number	:	1154378388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WAYNE RAHE M.D.

Provider Business Mailing Address
First Line	:	1011 N DEWEY AVE
Second Line	:	#100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1024
Country	:	US
Telephone Number	:	405-228-7100
Fax Number	:	405-228-7150

Provider Business Practice Location Address
First Line	:	1011 N DEWEY AVE
Second Line	:	#100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1024
Country	:	US
Telephone Number	:	405-228-7100
Fax Number	:	405-228-7150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/22/2010

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