Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3304 | OK |
NPI | 1477637940 |
---|---|
Provider Name | Dr. James Edward Raney |
First Address | Tulsa, OK 74133-1950 |
Second Address | Tulsa, OK 74133-1950 |
Gender | M |
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 |
---|---|---|
731601125-001 | BLUE CROSS BLUE SHIELD (01) | OK |
U84237 | (02) | OK |