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General NPI Number Information
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NPI Number | 1063513638
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Entity Type | Organization
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Legal Business Name | ALEXANDER P GURROLA MD PC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 812 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-5708
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Country | US
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Telephone | 580-226-6500
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Fax | 580-226-6524
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Provider Business Mailing Address
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Address Line | PO BOX 1986
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City | ARDMORE
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State | OK
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Zip | 73401-1986
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Country | US
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Telephone | 580-226-6500
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Fax | 580-226-6524
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ALEXANDER P GURROLA
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Credential | MD
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Telephone | 580-226-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 16537
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License Number State | OK
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