Individual
GARY DWAYNE RALEIGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
503 S ASPEN, BROKEN ARROW, OK 74012
(918) 331-9184
(918) 331-9187
Mailing address
6906 E 83RD ST N, OWASSO, OK 74055-7290
(918) 341-6873
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60070
OK
Other
Enumeration date
08/31/2007
Last updated
08/03/2010
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