Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4282 | OK |
NPI | 1134186299 |
---|---|
Provider Name | Boyd David Burns |
First Address | Tulsa, OK 74135-9923 |
Second Address | Tulsa, OK 74135-9923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 23/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200060540A | (05) | OK |
H86662 | (02) | OK |