Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT3927 | OK |
NPI | 1023198165 |
---|---|
Provider Name | Clay Warren |
First Address | Ada, OK 74820-2847 |
Second Address | Ada, OK 74820-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 24/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT3927 | OK LICENSE (01) | OK |