Organization
LUIS V GOROSPE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS V GOROSPE MD (PHYSICIAN)
(918) 252-2800
Entity
Organization
Contact information
Practice address
705 W QUEENS ST, BROKEN ARROW, OK 74012-1767
(918) 252-2800
(918) 252-2888
Mailing address
PO BOX 35567, TRIAD BANK, TULSA, OK 74153
(918) 252-2800
(918) 252-2888
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
10249
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110112850B
—
OK
Enumeration date
10/10/2007
Last updated
01/07/2011
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