Basic Information
| Provider Information | |||||||||
| NPI: | 1013090919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAVULA | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N PHILLIPS AVE | ||||||||
| Address2: | SUITE 10,000 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052714412 | ||||||||
| FaxNumber: | 4052713265 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N PHILLIPS AVE | ||||||||
| Address2: | SUITE 14500 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052715311 | ||||||||
| FaxNumber: | 4052713767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1312 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.