Provider Demographics
NPI:1932472271
Name:DOSHIER, GWEN C (COTA)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:C
Last Name:DOSHIER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18244 COUNTY LINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEX
Mailing Address - State:OK
Mailing Address - Zip Code:73002-2416
Mailing Address - Country:US
Mailing Address - Phone:405-397-7779
Mailing Address - Fax:
Practice Address - Street 1:18244 COUNTY LINE AVE
Practice Address - Street 2:
Practice Address - City:ALEX
Practice Address - State:OK
Practice Address - Zip Code:73002-2416
Practice Address - Country:US
Practice Address - Phone:405-397-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK994171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor