Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 20483 | OK |
NPI | 1053334078 |
---|---|
Provider Name | Dr. King Erwin Morris JR. |
First Address | Cushing, OK 74023-4139 |
Second Address | Cushing, OK 74023-4139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 06/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100217110B | (05) | OK |
G62567 | (02) |