Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 23991 | OK |
NPI | 1003957846 |
---|---|
Provider Name | Sandra Jean Gilliland |
First Address | Oklahoma City, OK 73139-2544 |
Second Address | Oklahoma City, OK 73139-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 31/03/2011 |