Provider Demographics
NPI:1346252947
Name:JOSEPH, GERALD (CRNA)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7476
Mailing Address - Country:US
Mailing Address - Phone:405-514-4786
Mailing Address - Fax:405-758-5582
Practice Address - Street 1:2001 CRADDUCK RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-9400
Practice Address - Country:US
Practice Address - Phone:405-514-4786
Practice Address - Fax:405-758-5354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0063042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200035860AMedicaid
OK200035860AMedicaid
OK231415905Medicare PIN