Provider Demographics
NPI:1659427391
Name:GILLOCK, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:GILLOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7170 S BRADEN AVE
Mailing Address - Street 2:# 175
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6329
Mailing Address - Country:US
Mailing Address - Phone:918-481-0994
Mailing Address - Fax:918-494-6747
Practice Address - Street 1:7170 S BRADEN AVE
Practice Address - Street 2:# 175
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6329
Practice Address - Country:US
Practice Address - Phone:918-481-0994
Practice Address - Fax:918-494-6747
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK129662083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine