Provider Demographics
NPI:1235636200
Name:GOWER, ANDRAYA (MD)
Entity Type:Individual
Prefix:
First Name:ANDRAYA
Middle Name:
Last Name:GOWER
Suffix:
Gender:F
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 54333
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-1333
Mailing Address - Country:US
Mailing Address - Phone:405-803-8020
Mailing Address - Fax:405-437-2332
Practice Address - Street 1:13301 N MERIDIAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8381
Practice Address - Country:US
Practice Address - Phone:405-803-8020
Practice Address - Fax:405-437-2332
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34799207N00000X, 207N00000X
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program