Healthcare Provider Details

I. General information

NPI: 1124552286
Provider Name (Legal Business Name): GAVELY TOOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OU CHILDREN'S ER 1200 N CHILDREN'S AVE
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

940 NE 13TH ST STE 2G2300
OKLAHOMA CITY OK
73104-5008
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone: 405-271-2429
  • Fax: 405-271-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6510
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberU8446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: