Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 1038 | OK |
NPI | 1386787661 |
---|---|
Provider Name | Dr. Lisa Myers Black |
First Address | Norman, OK 73071-7749 |
Second Address | Norman, OK 73071-7749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |