Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5482 | OK |
NPI | 1033601752 |
---|---|
Provider Name | Alyxandria Calvert |
First Address | Tulsa, OK 74135-2606 |
Second Address | Tulsa, OK 74135-2606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 30/05/2018 |