Individual
MR. MARK GOSNELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
7050 AIR DEPOT BLVD, TINKER AFB, OK 73145-8716
(405) 582-6055
Mailing address
7050 AIR DEPOT BLVD, TINKER AFB, OK 73145-8716
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/13/2017
Last updated
07/13/2017
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