Provider Demographics
NPI:1952123580
Name:GOBBLE, GREGORY SCOTT
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:GOBBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S XANTHUS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2621
Mailing Address - Country:US
Mailing Address - Phone:918-900-3421
Mailing Address - Fax:
Practice Address - Street 1:12505 E 37TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3204
Practice Address - Country:US
Practice Address - Phone:918-652-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist