Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 29436 | OK |
N | 207RI0200X | Infectious Disease | M9597 | TX |
NPI | 1093854093 |
---|---|
Provider Name | Brannon Raney |
First Address | Tulsa, OK 74136-8354 |
Second Address | Tulsa, OK 74136-8354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8BQ792 | BCBS (01) | TX |