Gwen Fuentes MD Pediatric Clinic

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

13171 Issued in OK

Legal business name

GWEN FUENTES MD PEDIATRIC CLINIC

Practice address

919 15TH Ave NW
Ardmore, OK 73401-1809

Phone

(580) 223-5693

Fax

(580) 223-8909

NPI assigned

Apr 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gwen Canarias Fuentes, M.D.NPI 1013914324

Title

Owner

Phone

(580) 223-5693

Specialties & licenses 2

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwen Canarias Fuentes, M.D.

  • Pediatrics Physician
  • Ardmore, OK
  • NPI 1013914324
  NPD Authorized official

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296345600000",
    "number": "1083830608",
    "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": {
        "organization_name": "GWEN FUENTES MD PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2011-01-30",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "CANARIAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-223-5693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "13171",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OK",
            "license": "13171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100209330A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100209330C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nilesh Gupta, M.D.
• Alexander P. Gurrola, MD
• Jamie Lynn Guthrie, DDS
• Vanessa Gutierrez
• Denise Gutirrez-Miller
• Ashraf S Habib, MD
• Hac, Inc. (Homeland Pharmacy #169)
• Heather Hacker
• Blanca Sela Hackler
• Savahanna Haggard

• Medical Specialty Clinic/Center in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Medical Specialty Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.