Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 25452 | OK |
NPI | 1063479053 |
---|---|
Provider Name | Dr. Raymond Joseph Sanders |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74136-1907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165489001 | (05) | AR |
200104900A | (05) | OK |
200461180A | (05) | KS |
206347304 | (05) | MO |