Provider Demographics
NPI:1801331970
Name:MCPHERSON, GREGORY II
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MCPHERSON
Suffix:II
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 1:16304 OKALEE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1290
Mailing Address - Country:US
Mailing Address - Phone:405-905-9323
Mailing Address - Fax:
Practice Address - Street 1:16304 OKALEE LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1290
Practice Address - Country:US
Practice Address - Phone:405-905-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK082551708171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator