Healthcare Provider Details

I. General information

NPI: 1164451084
Provider Name (Legal Business Name): LAURA S GILMORE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N BROADWAY
CARNEGIE OK
73015
US

IV. Provider business mailing address

1813 ABILENE CT
GRAND PRAIRIE TX
75052-2200
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1050
  • Fax: 580-654-9979
Mailing address:
  • Phone: 405-474-7757
  • Fax: 405-410-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LAURA SHANNON GILMORE
Title or Position: OWNER
Credential: MD
Phone: 580-465-2901