Provider Demographics
NPI:1144324625
Name:GERARD, TERRY R (DO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:GERARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26303
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0303
Mailing Address - Country:US
Mailing Address - Phone:918-582-0001
Mailing Address - Fax:918-582-0003
Practice Address - Street 1:8803 S 101ST E AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-582-0001
Practice Address - Fax:918-582-0003
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2040207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100162190AMedicaid
KS2456392702OtherTIED TO SS#
OK462507531-006OtherBCBS TIED TO 73-1554259
KS2456392702Medicaid