Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 10565 | OK |
N | 207RI0011X | Interventional Cardiology | 10565 | OK |
NPI | 1003810029 |
---|---|
Provider Name | Gary Lee Worcester |
First Address | Oklahoma City, OK 73112-4430 |
Second Address | Oklahoma City, OK 73112-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |