Provider Demographics
NPI:1205819570
Name:MCGOURAN, FRANCIS JAMES III (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:JAMES
Last Name:MCGOURAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F.
Other - Middle Name:JAMES
Other - Last Name:MCGOURAN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1334 N HARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1514
Mailing Address - Country:US
Mailing Address - Phone:580-255-8564
Mailing Address - Fax:580-255-8640
Practice Address - Street 1:1334 N HARVILLE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1514
Practice Address - Country:US
Practice Address - Phone:580-255-8564
Practice Address - Fax:580-255-8640
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100058840DMedicaid
OK412151590001OtherBLUE CROSS BLUE SHIELD
OK37D1015844OtherCLIA NUMBER
OKP00183712OtherRAILROAD MEDICARE PIN
OK100058840DMedicaid
OK412151590OtherTIN
OKE57396Medicare UPIN
OK243502600Medicare PIN