Gwen Canarias Fuentes, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

13171 Issued in OK

Practice address

919 15TH Ave NW
Ardmore, OK 73401-1809

Phone

(580) 223-5693

Fax

(580) 223-8909

NPI assigned

Jun 30, 2005

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gwen Fuentes MD Pediatric Clinic

  • Medical Specialty Clinic/Center
  • Ardmore, OK
  • NPI 1083830608

  Pediatrics

  NPD Authorized official
• Mercy Hospital Ardmore, Inc.

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1386741635
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1013914324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011809",
            "telephone_number": "580-223-5693",
            "fax_number": "580-223-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011809",
            "telephone_number": "580-223-5693",
            "fax_number": "580-223-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "GWEN",
        "middle_name": "CANARIAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "13171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nevaeh Freeman
• Frelyn Loughridge Family Nurse Practitioner PC
• Kourtney French
• Lori Suzanne Frock, RN
• Andrea Fuentes
• Jo L Fuller, APRN-CNP
• Stephanie Celeste Fulmer
• Functionality Therapy Services PLLC
• Fundamentals Therapy Clinic
• Stephanie Kay Furrh

• Pediatrics Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.