Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 6433 | OK |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6433 | OK |
NPI | 1689929184 |
---|---|
Provider Name | Dr. Ronald Faram |
First Address | Tahlequah, OK 74464 |
Second Address | Oklahoma City, OK 73117-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200006220A | (05) | OK |