Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 1987 | OK |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1987 | OK |
NPI | 1235139692 |
---|---|
Provider Name | Anthony Cruse |
First Address | Oklahoma City, OK 73139-9402 |
Second Address | Oklahoma City, OK 73139-9402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 07/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E09800 | (02) | OK |