Individual
DR. GERARD OHANNES OGHLAKIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2115 S FREMONT AVE, STE 4300, SPRINGFIELD, MO 65804-2239
(417) 820-3911
(417) 820-3924
Mailing address
2115 S FREMONT AVE STE 4300, SPRINGFIELD, MO 65804-2232
(417) 820-3911
(417) 820-3924
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
2011006602
MO
207RC0000X
Cardiovascular Disease Physician
2011006602
MO
207RC0000X
Cardiovascular Disease Physician
TRAINING LICENSE
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679779979
—
MO
05
—
188964001
—
AR
01
—
431560263
TRICARE
MO
01
—
P00954926
RR MCR
MO
Enumeration date
06/23/2007
Last updated
11/28/2017
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