Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 7798 | OK |
NPI | 1083918668 |
---|---|
Provider Name | Billy Paul Loughridge |
First Address | Tulsa, OK 74152-1057 |
Second Address | Tulsa, OK 74152-1057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 22/12/2010 |