Provider Demographics
NPI:1306985882
Name:GILMORE, BRUCE STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEWART
Last Name:GILMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:830 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-0804
Mailing Address - Country:US
Mailing Address - Phone:580-226-4259
Mailing Address - Fax:
Practice Address - Street 1:1015 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5018
Practice Address - Country:US
Practice Address - Phone:580-223-2266
Practice Address - Fax:580-221-5690
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E11728Medicare UPIN