Organization

F.G.M.A. ,llc.

May also be knows as Family And Geriatric Medical Associates

Family Nurse Practitioner in Oklahoma City, OK(View on Map)

Legal Business Name

F.G.M.A. ,llc.

Also Known As

Family And Geriatric Medical Associates

NPI Number

1922136480

NPI Type

Organization

Enumeration Date

02/28/2007

Specialties

(Taxonomies)

Code

363LF0000X

Primary Taxonomy

Yes

Licenses

State

Oklahoma

License Number

R0028064

Contact
Information

Purpose

Mailing
Location

Address

5622 N PORTLAND AVE
5622 N PORTLAND AVE

City

Oklahoma City
Oklahoma City

State

OK
OK

Postal Code

73112-2096
73112-2096

Country

US
US

Telephone Number

(405) 917-7590
(405) 917-7590

Authorized Official

Name

Susan Grandle

Title or Position

NURSE PRACTITIONER

Telephone Number

(405) 917-7590

Identifiers

Identifier

100216830D
R0028064

Identifier State

OK
OK

Identifier Issuer

Unknown
SUSAN GRANDLE LIC #

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 06/04/2015

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