Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 390200000X | OK |
NPI | 1285951186 |
---|---|
Provider Name | Dr. Ryan Daniel Gholson |
First Address | Tulsa, OK 74107-2726 |
Second Address | Tulsa, OK 74127-9005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2010 |
Last Update Date | 10/07/2020 |