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Individual

DR. GARY W BREIPOHL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9423 E 95TH CT, TULSA, OK 74133-5805
(918) 496-2400
(405) 948-6507
Mailing address
DEPT 1654, TULSA, OK 74182-0001
(405) 947-8585
(405) 948-6507

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
16657
OK
207L00000X
Anesthesiology Physician
Primary
54361
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050072987
RAILROAD MEDICARE
OK
05
100194990C
OK
01
4854514
CIGNA
OK
Enumeration date
09/16/2005
Last updated
11/20/2017
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