Provider Demographics
NPI:1104835651
Name:MAYO DEAN GILSON,MD,INC
Entity type:Organization
Organization Name:MAYO DEAN GILSON,MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-463-0411
Mailing Address - Street 1:12400 VAL VERDE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5436
Mailing Address - Country:US
Mailing Address - Phone:405-463-0411
Mailing Address - Fax:405-748-3822
Practice Address - Street 1:12400 VAL VERDE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5436
Practice Address - Country:US
Practice Address - Phone:405-463-0411
Practice Address - Fax:405-748-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8854207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSSN