Provider Demographics
NPI:1033193776
Name:GURROLA, ALEXANDER P (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:GURROLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1986
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1986
Mailing Address - Country:US
Mailing Address - Phone:580-226-6500
Mailing Address - Fax:580-226-6524
Practice Address - Street 1:812 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5708
Practice Address - Country:US
Practice Address - Phone:580-226-6500
Practice Address - Fax:580-226-6524
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16537207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100214670AMedicaid
OK100214670AMedicaid
E08020Medicare UPIN