Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 17707 | OK |
NPI | 1083656912 |
---|---|
Provider Name | Dr. Daron Gene Street |
First Address | Tulsa, OK 74146-6236 |
Second Address | Tulsa, OK 74146-6236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/05/2014 |