Provider Demographics
NPI:1215977798
Name:CANADAY, GUS D JR (ARNP)
Entity type:Individual
Prefix:MR
First Name:GUS
Middle Name:D
Last Name:CANADAY
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S GARNETT RD
Mailing Address - Street 2:STE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1811
Mailing Address - Country:US
Mailing Address - Phone:918-437-2500
Mailing Address - Fax:918-437-2535
Practice Address - Street 1:1312 S GARNETT RD
Practice Address - Street 2:SUITE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1811
Practice Address - Country:US
Practice Address - Phone:918-437-2500
Practice Address - Fax:918-437-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0067546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100171360BMedicaid