Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 5219 | OK |
N | 207QS0010X | Family Doctor - Sports Medicine | OS017248 | PA |
NPI | 1003107855 |
---|---|
Provider Name | Dr. Darin Alan Gwartney |
First Address | Pryor, OK 74361-8850 |
Second Address | Pryor, OK 74361-8850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 03/08/2015 |