Individual
MR. JERRY ALLEN GOOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 NE 13TH ST., VA MEDICAL CENTER, OKLAHOMA CITY, OK 73104-5028
(405) 795-3779
Mailing address
RT 1 BOX 569, CASHION, OK 73016
(405) 795-3779
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
64744
OK
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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