Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3519 | OK |
N | 111NN0400X | Neurology | 3519 | OK |
NPI | 1457435968 |
---|---|
Provider Name | Dr. Bobi Laru Raney |
First Address | Tulsa, OK 74133-1950 |
Second Address | Tulsa, OK 74133-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20200 | BLUELINES PROVIDER # (01) | OK |
731601125 0003 | CIGNA PROVIDER # (01) | OK |
73160112500 | HEALTHCHOICE PROVIDER # (01) | OK |
U84240 | (02) | OK |