Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 3484 | OK |
NPI | 1093795510 |
---|---|
Provider Name | Clell W Pond |
First Address | Norman, OK 73070-5358 |
Second Address | Tulsa, OK 74133-5716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100096560C | (05) | OK |
H22600 | (02) |