Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 257 | OK |
NPI | 1003014077 |
---|---|
Provider Name | Dr. Larry Hale Pittman JR. |
First Address | Edmond, OK 73083-2348 |
Second Address | Muskogee, OK 74403-4957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 13/10/2009 |