Individual
TOM J GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4111 S DARLINGTON AVE, STE 700, TULSA, OK 74135-6348
(918) 743-8943
(918) 743-9058
Mailing address
PO BOX 4939, TULSA, OK 74159-0939
(918) 743-8943
(918) 743-9058
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
765
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087830B
—
OK
Enumeration date
11/21/2005
Last updated
08/28/2013
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