Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20769 | OK |
NPI | 1003010869 |
---|---|
Provider Name | Dr. Julie R Mcintosh |
First Address | Porter, OK 74454-2749 |
Second Address | Porter, OK 74454-2749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 21/03/2013 |