Provider Demographics
NPI:1326029299
Name:BOGIE, GEMINI J (MD)
Entity type:Individual
Prefix:
First Name:GEMINI
Middle Name:J
Last Name:BOGIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 258881-8881
Mailing Address - Street 2:SECTION# 141
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125
Mailing Address - Country:US
Mailing Address - Phone:405-418-4800
Mailing Address - Fax:405-418-4820
Practice Address - Street 1:5622 N PORTLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2000
Practice Address - Country:US
Practice Address - Phone:405-528-8193
Practice Address - Fax:405-528-0626
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20219207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100119270BMedicaid
180040189Medicare PIN
OK$$$$$$$$$Medicare PIN
H18304Medicare UPIN