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General NPI Number Information
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NPI Number | 1164451084
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Entity Type | Organization
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Legal Business Name | LAURA S GILMORE MD PC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 102 N BROADWAY
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City | CARNEGIE
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State | OK
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Zip | 73015
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Country | US
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Telephone | 580-654-1050
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Fax | 580-654-9979
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Provider Business Mailing Address
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Address Line | 1813 ABILENE CT
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-2200
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Country | US
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Telephone | 405-474-7757
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Fax | 405-410-9795
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Authorized Official
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Title or Position | OWNER
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Name | LAURA SHANNON GILMORE
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Credential | MD
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Telephone | 580-465-2901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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