Organization
LAURA S GILMORE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA SHANNON GILMORE MD (OWNER)
(580) 465-2901
Entity
Organization
Contact information
Practice address
102 N BROADWAY, CARNEGIE, OK 73015
(580) 654-1050
(580) 654-9979
Mailing address
1813 ABILENE CT, GRAND PRAIRIE, TX 75052-2200
(405) 474-7757
(405) 410-9795
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200086460A
—
OK
01
—
200086480A
MEDICAID INDIVIDUAL #
OK
01
—
242623001
MEDICARE INDIVIDUAL PIN #
OK
Enumeration date
07/02/2006
Last updated
01/12/2024
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