Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 4942 | OK |
NPI | 1265761381 |
---|---|
Provider Name | Dr. Holly Jean Dawson |
First Address | Tulsa, OK 74136-3361 |
Second Address | Fort Gibson, OK 74434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2009 |
Last Update Date | 29/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4942 | OK LICENSE (01) | OK |