Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | MED R3H73 | MO |
NPI | 1013954593 |
---|---|
Provider Name | Brian S Skrainka |
First Address | Jenks, OK 74037-9004 |
Second Address | Jenks, OK 74037-9004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 17/02/2020 |