Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0434797 | KS |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 34598 | OK |
NPI | 1265607592 |
---|---|
Provider Name | Dr. Sunil Menon |
First Address | Ponca City, OK 74601-1929 |
Second Address | Ponca City, OK 74601-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 16/09/2020 |