Provider Demographics
NPI:1447516430
Name:MYRIN, GERARDO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:MYRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5550
Mailing Address - Country:US
Mailing Address - Phone:405-713-9940
Mailing Address - Fax:405-713-9941
Practice Address - Street 1:5401 N PORTLAND AVE STE 600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2121
Practice Address - Country:US
Practice Address - Phone:405-713-9940
Practice Address - Fax:405-713-9941
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK33739207X00000X
TXBP10042747207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery