Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 20875 | OK |
NPI | 1174511042 |
---|---|
Provider Name | David W Miller |
First Address | Tulsa, OK 74182-0001 |
Second Address | Broken Arrow, OK 74127-9020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 27/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100021790B | (05) | OK |
G52918 | (02) |