Individual
GREGORY RAYMOND FAVORITE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
103 W MAIN STREET, RINGLING, OK 73456
(580) 662-2078
(580) 662-2085
Mailing address
PO BOX 649, 103 W MAIN STREET, RINGLING, OK 73456
(580) 662-2085
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00714
OK
Other
Enumeration date
05/30/2006
Last updated
07/08/2007
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