Healthcare Provider Details

I. General information

NPI: 1477872653
Provider Name (Legal Business Name): GERRON ALEXANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6724 N MARTIN LUTHER KING AVE
OKLAHOMA CITY OK
73111-7943
US

IV. Provider business mailing address

2301 NW 122ND ST APT 3406
OKLAHOMA CITY OK
73120-8459
US

V. Phone/Fax

Practice location:
  • Phone: 405-475-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number232844
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: