Provider Demographics
NPI:1154391084
Name:GOSCIN, LEE ALICE (MD, PHD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ALICE
Last Name:GOSCIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7520
Mailing Address - Country:US
Mailing Address - Phone:918-423-4900
Mailing Address - Fax:918-423-4907
Practice Address - Street 1:101 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7520
Practice Address - Country:US
Practice Address - Phone:918-423-4900
Practice Address - Fax:918-423-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29464207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200457750AMedicaid
OK262051YLY6Medicare PIN