Provider Demographics
NPI:1487997987
Name:BIRKS, GARY (CO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BIRKS
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 24TH AVE NW
Mailing Address - Street 2:SUITE110
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1018 24TH AVE NW
Practice Address - Street 2:SUITE110
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6543
Practice Address - Country:US
Practice Address - Phone:405-310-3344
Practice Address - Fax:405-310-3340
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK99832OtherPRIVATE INSURANCE