MEDICARE: GERALD F PRIBIL MD

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	207Q00000X	Family Medicine Physician	12275	OK

General Provider Information

NPI Number	:	1376535294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD F PRIBIL MD

Provider Business Mailing Address
First Line	:	226 SE DEBELL AVE BLDG A
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2343
Country	:	US
Telephone Number	:	918-331-3760
Fax Number	:	918-331-3761

Provider Business Practice Location Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 300
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-331-3760
Fax Number	:	918-331-3761

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	06/03/2011

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