Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 17776 | OK |
NPI | 1053318162 |
---|---|
Provider Name | Dr. Patricia Ingham Overhulser |
First Address | Oklahoma City, OK 73104-5010 |
Second Address | Oklahoma City, OK 73104-5010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 20/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E01243 | (02) |