Individual
JOHNSON C GOURD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9912 E 21ST ST, TULSA, OK 74129-1620
(918) 622-0641
(918) 622-0683
Mailing address
9912 E 21ST ST, TULSA, OK 74129-1620
(918) 622-0641
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23087
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200020000A
—
OK
Enumeration date
05/19/2006
Last updated
04/11/2011
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