Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4441 | OK |
NPI | 1528734787 |
---|---|
Provider Name | Dan Galyean |
First Address | Edmond, OK 73025-2637 |
Second Address | Edmond, OK 73013-3615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |