Provider Demographics
NPI:1508246570
Name:GILLISPIE, ALLON (DO)
Entity Type:Individual
Prefix:
First Name:ALLON
Middle Name:
Last Name:GILLISPIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 ERICA CIR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-2400
Mailing Address - Country:US
Mailing Address - Phone:580-656-0626
Mailing Address - Fax:
Practice Address - Street 1:2515 N WHISENANT DR STE 301
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2684
Practice Address - Country:US
Practice Address - Phone:580-251-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0356R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1508246570Medicaid