Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 21970 | OK |
Y | 208600000X | Surgeon | 21970 | OK |
NPI | 1003893561 |
---|---|
Provider Name | Brady S Hagood |
First Address | Oklahoma City, OK 73196-0001 |
Second Address | Yukon, OK 73099-6396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 16/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I30819 | (02) | OK |