Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 11827 | OK |
N | 207R00000X | Internist | 11827 | OK |
N | 111NI0900X | Internist | 11827 | OK |
NPI | 1205872199 |
---|---|
Provider Name | Dr. Ambrosio A Solano |
First Address | Oklahoma City, OK 73134-1785 |
Second Address | Woodward, OK 73801-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100229540A | (05) | OK |
D35294 | (02) | OK |