Individual
MARK R. GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6160 S YALE AVE, TULSA, OK 74136-1930
(918) 495-2600
(918) 497-3007
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
(918) 488-6010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1178
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062820A
—
OK
Enumeration date
04/28/2006
Last updated
08/05/2013
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