Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 16537 | OK |
NPI | 1033193776 |
---|---|
Provider Name | Alexander P. Gurrola |
First Address | Ardmore, OK 73402-1986 |
Second Address | Ardmore, OK 73401-5708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100214670A | (05) | OK |
E08020 | (02) |