Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 14360 | OK |
NPI | 1003815226 |
---|---|
Provider Name | Bruce Lee Splane |
First Address | Tulsa, OK 74136-3310 |
Second Address | Tulsa, OK 74135-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 29/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C95513 | (02) |