Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | T-7293 | OK |
Y | 213EG0000X | General Practice | T-7293 | OK |
NPI | 1003431123 |
---|---|
Provider Name | Dr. Benjamin Nicolas Cuevas |
First Address | Kingfisher, OK 73750-4944 |
Second Address | Kingfisher, OK 73750-4944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 15/06/2020 |