Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 3573 | OK |
NPI | 1003813924 |
---|---|
Provider Name | Dr. Noel E Gattenby |
First Address | Tulsa, OK 74136-3331 |
Second Address | Tulsa, OK 74133-6919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 10/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100107770A | (05) | OK |