Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4124 | OK |
Y | 213EG0000X | General Practice | 4124 | OK |
NPI | 1003843103 |
---|---|
Provider Name | Dr. Jerry D Mccan X |
First Address | Tuttle, OK 73089-7929 |
Second Address | Tuttle, OK 73089-7929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |