Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 23551 | OK |
N | 208600000X | Surgeon | 23551 | OK |
Y | 208C00000X | Colorectal Surgeon | 23551 | OK |
NPI | 1003886490 |
---|---|
Provider Name | Carmen Ruiz |
First Address | Oklahoma City, OK 73126-8838 |
Second Address | Tulsa, OK 74104-5635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 27/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200019610B | (05) | OK |
H41703 | (02) |