Gwen Fuentes Md Pediatric Clinic

NPI 1083830608 - Pediatrics - 208000000X

NPI Details
NPI 1083830608
Enumeration Date 04/18/2007
Last Updated 01/30/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name GWEN CANARIAS GWEN
Position OWNER
Phone (580) 223-5693
Fax (580) 223-8909
Practice Location
919 15TH AVE NW
ARDMORE OK, 73401-1809, US
Phone (580) 223-5693
Fax (580) 223-8909
Business Location
919 15TH AVE NW
ARDMORE OK, 73401-1809, US
Phone (580) 223-5693
Fax (580) 223-8909
Toxanomy
Taxonomy Code 208000000X
License State Oklahoma
License Number 13171
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According to our database, Gwen Fuentes Md Pediatric Clinic NPI is 1083830608, taxonomy code is 208000000X and license number is 13171, license state is located at Oklahoma. Gwen Fuentes Md Pediatric Clinic physically located at 919 15th Ave Nw, Ardmore OK, 73401-1809. NPI Number 1033115704 has the healthcare provider type.

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1083830608 NPI number is provided on an as is basis without warranty of any kind. 1083830608 is maintained by the National Plan & Provider Enumeration System. The contents of Gwen Fuentes Md Pediatric Clinic are for informational purposes only.