Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 93257 | OK |
Y | 2080P0214X | Pediatric Pulmonologist | 93257 | OK |
NPI | 1366950743 |
---|---|
Provider Name | Bucy Annie Rajan Thomas |
First Address | Yukon, OK 73099-2343 |
Second Address | Bethany, OK 73008-2513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2018 |
Last Update Date | 17/07/2020 |