Provider Demographics
NPI:1760707863
Name:GORANSON, ERIN NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:NICOLE
Last Name:GORANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13401 N WESTERN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1407
Mailing Address - Country:US
Mailing Address - Phone:405-252-3450
Mailing Address - Fax:405-252-3499
Practice Address - Street 1:13401 N WESTERN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1407
Practice Address - Country:US
Practice Address - Phone:405-252-3450
Practice Address - Fax:405-252-3499
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK29724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics