Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8480 | OK |
NPI | 1003343831 |
---|---|
Provider Name | Dr. Robert Capehart |
First Address | Tulsa, OK 74159-0410 |
Second Address | Tulsa, OK 74120-7409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |