Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 5502 | OK |
NPI | 1043509474 |
---|---|
Provider Name | Britney Else |
First Address | Tulsa, OK 74137-7423 |
Second Address | Tulsa, OK 74137-7423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 24/08/2015 |