Healthcare Provider Details

I. General information

NPI: 1134732332
Provider Name (Legal Business Name): ASHTON MCKINZI GORES MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

1823 E 17TH PL
TULSA OK
74104-5308
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4000
  • Fax: 918-236-4001
Mailing address:
  • Phone: 580-222-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47379
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: