Provider Demographics
NPI:1427693399
Name:GILPEN, JOHNNIE LEE JR
Entity type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:LEE
Last Name:GILPEN
Suffix:JR
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 1:7997 ALFADALE ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73090-6615
Mailing Address - Country:US
Mailing Address - Phone:405-919-9511
Mailing Address - Fax:
Practice Address - Street 1:7997 ALFADALE ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:OK
Practice Address - Zip Code:73090-6615
Practice Address - Country:US
Practice Address - Phone:405-919-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3116207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine