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General NPI Number Information
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NPI Number | 1508246570
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Entity Type | Individual
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Provider Name | ALLON GILLISPIE DO
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Gender | Male
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 2515 N WHISENANT DR STE 301
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City | DUNCAN
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State | OK
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Zip | 73533-2684
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Country | US
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Telephone | 580-251-6806
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Fax |
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Provider Business Mailing Address
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Address Line | 3014 ERICA CIR
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City | DUNCAN
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State | OK
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Zip | 73533-2400
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Country | US
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Telephone | 580-656-0626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0356R
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License Number State | OK
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