Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 20598 | OK |
NPI | 1134209273 |
---|---|
Provider Name | Dr. James Creed Spann |
First Address | Tulsa, OK 74104-4243 |
Second Address | Tulsa, OK 74133-5718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 01/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100074920A | (05) | OK |
1134209273 | OK STATE EMPLOYEES (HEALTHCHOICE (01) | OK |
134328001 | (05) | AR |
295A | MEDICARE (01) | AR |
5I124 | BLUE CROSS BLUE SHIELD (01) | AR |
G65847 | (02) | OK |
P01068164 | RAILROAD MEDICARE (01) |