Individual
GABE WILLBOURN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6216 S LEWIS AVE STE 102, TULSA, OK 74136-1075
(918) 416-4483
Mailing address
4507 E 6TH ST, TULSA, OK 74112-4201
(918) 764-0078
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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