Individual
PAULA DAUGHERTY GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
4300 W MEMORIAL RD, OKLAHOMA CITY, OK 73120-8304
(405) 752-3640
Mailing address
18108 PROVIDENCE AVE, EDMOND, OK 73012-4142
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD163
OK
Other
Enumeration date
10/01/2009
Last updated
10/01/2009
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