Individual
JESSE A GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
1505 E MAIN ST, STIGLER, OK 74462-2913
(918) 967-3368
(918) 967-3351
Mailing address
PO BOX 179, STIGLER, OK 74462-0179
(918) 967-3368
(918) 967-4582
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1001555
OK
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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