Provider Demographics
NPI:1215982731
Name:DICKMAN, GERALD LEWIS (DO, PLLC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEWIS
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:DO, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NW EXPRESSWAY
Mailing Address - Street 2:BLDG. C, SUITE 604
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-945-4828
Mailing Address - Fax:405-945-4829
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:BLDG. C, SUITE 604
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-945-4828
Practice Address - Fax:405-945-4829
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics