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NPI Code Detail

MEDICARE: DR. GARY PATZKOWSKY D.O.

MEDICARE: DR. GARY PATZKOWSKY D.O.
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
1207Q00000XFamily Medicine Physician1761OK
22083X0100XOccupational Medicine Physician1761OK

General Provider Information

NPI Number : 1912990896
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY PATZKOWSKY D.O.
Provider Business Mailing Address
First Line : 5300 N INDEPENDENCE AVE
Second Line : 280
City : OKLAHOMA CITY
State : OK
Zip : 73112-5556
Country : US
Telephone Number : 580-234-1112
Fax Number : 580-548-1538
Provider Business Practice Location Address
First Line : 401 S 3RD ST
Second Line :
City : ENID
State : OK
Zip : 73701-5737
Country : US
Telephone Number : 580-548-1112
Fax Number : 580-548-1538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 02/12/2018

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