Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1235684499 |
---|---|
Provider Name | Arthur Randall |
First Address | Oklahoma City, OK 73116 |
Second Address | Oklahoma City, OK 73116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2016 |
Last Update Date | 17/08/2016 |