Provider Demographics
NPI:1306884812
Name:ADULT GASTROENTEROLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:ADULT GASTROENTEROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLIEWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-481-4700
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0305
Mailing Address - Country:US
Mailing Address - Phone:918-438-7050
Mailing Address - Fax:918-221-0835
Practice Address - Street 1:4200 E SKELLY DR STE 700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3256
Practice Address - Country:US
Practice Address - Phone:918-438-7050
Practice Address - Fax:918-221-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740890AMedicaid
OK100740890AMedicaid