Provider Demographics
NPI:1861760837
Name:GILLERAN, JOHN BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERNARD
Last Name:GILLERAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122
Mailing Address - Country:US
Mailing Address - Phone:405-946-5782
Mailing Address - Fax:405-946-1489
Practice Address - Street 1:4940 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122
Practice Address - Country:US
Practice Address - Phone:405-946-5782
Practice Address - Fax:405-946-1489
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8586207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty