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Individual

MARK D GAGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
6915 E 106TH ST, TULSA, OK 74133-7137
(918) 671-9274
Mailing address
PO BOX 140156, BROKEN ARROW, OK 74014-0002
(918) 357-5859
(918) 357-5859

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
3028
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100216450A
OK
Enumeration date
06/09/2006
Last updated
11/27/2024
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