Individual
DR. LUIS VENTURA GOROSPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 W QUEENS ST, BROKEN ARROW, OK 74012-1767
(918) 252-2800
(918) 252-2888
Mailing address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-1240
(918) 485-9701
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
10249
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112850A
—
OK
Enumeration date
06/24/2006
Last updated
09/09/2013
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