Individual
GARY T. DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3400 SE FRANK PHILLIPS #502, BARTLESVILLE, OK 74006
(918) 331-2577
(918) 331-2513
Mailing address
3400 SE FRANK PHILLIPS, STE 502, BARTLESVILLE, OK 74006-2495
(918) 331-2577
(918) 331-2513
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
05-24469
KS
207RC0000X
Cardiovascular Disease Physician
0524469
KS
207RC0000X
Cardiovascular Disease Physician
Primary
3077
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106620A
—
OK
05
—
101863
—
KS
Enumeration date
04/10/2006
Last updated
11/04/2011
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