Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4687 | OK |
NPI | 1124133061 |
---|---|
Provider Name | Dr. Lester Lyman Cowden III |
First Address | Oklahoma City, OK 73120-2036 |
Second Address | Oklahoma City, OK 73120-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U40341 | (02) | OK |