Individual
COLLEEN L GALLIMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505
(580) 357-4339
(580) 357-4423
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
APA1505
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200073860A
—
OK
Enumeration date
01/17/2006
Last updated
08/01/2008
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