Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 1343 | OK |
NPI | 1043239411 |
---|---|
Provider Name | Dr. Richard Ross Polk |
First Address | Tulsa, OK 74105-1744 |
Second Address | Tulsa, OK 74105-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E15998 | (02) | OK |