Individual
DR. OWEN BUCK GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
525 W DOWNING ST, TAHLEQUAH, OK 74464-2713
(918) 458-3100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21767
OK
207Q00000X
Family Medicine Physician
C-6488
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100124330A
—
OK
05
—
110938001
—
AR
Enumeration date
08/10/2005
Last updated
07/08/2007
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