Provider Demographics
NPI:1891034765
Name:GALLES, PAM LAVERN
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:LAVERN
Last Name:GALLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HOPPE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2313
Mailing Address - Country:US
Mailing Address - Phone:580-559-0810
Mailing Address - Fax:580-272-5734
Practice Address - Street 1:111 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-5301
Practice Address - Country:US
Practice Address - Phone:405-331-2300
Practice Address - Fax:405-331-2302
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator