Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 24815 | OK |
N | 111NI0900X | Internist | 24815 | OK |
N | 207RC0000X | Internist - Cardiovascular Disease | 209845 | MA |
N | 207RC0000X | Internist - Cardiovascular Disease | 24815 | OK |
N | 207RI0011X | Interventional Cardiology | 209845 | MA |
Y | 207RI0011X | Interventional Cardiology | 24815 | OK |
NPI | 1013973304 |
---|---|
Provider Name | Branislav Schifferdecker |
First Address | Oklahoma City, OK 73132-3385 |
Second Address | Oklahoma City, OK 73120-8382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200086870A | (05) | OK |
I19224 | (02) | OK |
PENDING | RAILROAD MEDICARE (01) | OK |