Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7414 | OK |
N | 1223G0001X | General Practice | 7414 | OK |
N | 213EG0000X | General Practice | 7414 | OK |
NPI | 1164097747 |
---|---|
Provider Name | Dr. Nicholas Busby |
First Address | Okmulgee, OK 74447-6303 |
Second Address | Okmulgee, OK 74447-6303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 25/05/2021 |