Organization
WALTERS FAMILY CLINIC
Active
Other names
Larry Goss M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLORIA E VAUGHN (OFFICE MANAGER)
(580) 875-3320
Entity
Organization
Contact information
Practice address
102 N BROADWAY ST, WALTERS, OK 73572-1258
(580) 875-3320
(580) 875-3131
Mailing address
102 N BROADWAY ST, WALTERS, OK 73572-1258
(580) 875-3320
(580) 875-3131
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
10340
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200134580A
—
OK
01
—
37D1084232
CLIA
OK
Enumeration date
02/10/2008
Last updated
06/06/2008
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