Individual
JEFFREY ALAN GASTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1004 N 19TH AVE, BLDG 2, DURANT, OK 74701-3016
(580) 931-9135
(580) 931-9161
Mailing address
239 EAGLELAKE DR, DURANT, OK 74701-7421
(580) 745-9733
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
3950
OK
207Q00000X
Family Medicine Physician
Primary
3950
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200026040A
—
OK
Enumeration date
06/09/2005
Last updated
01/03/2011
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