Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 26794 | OK |
NPI | 1003094665 |
---|---|
Provider Name | Dr. Cory Brit Kebert |
First Address | Sapulpa, OK 74066-4513 |
Second Address | Tulsa, OK 74104-5346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 07/12/2017 |