Individual
DR. RON MITCHLIN GANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10512 NORTH 110TH EAST AVENUE, SUITE 300, OWASSO, OK 74055-6638
(918) 376-8900
(918) 376-8990
Mailing address
10512 NORTH 110TH EAST AVENUE, SUITE 300, OWASSO, OK 74055-6638
(918) 376-8900
(918) 376-8990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4408
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200097630B
—
OK
Enumeration date
09/15/2006
Last updated
05/01/2014
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