Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 17478 | OK |
Y | 208600000X | Surgeon | 17478 | OK |
N | 2086S0127X | Trauma Surgeon | 17478 | OK |
NPI | 1215966601 |
---|---|
Provider Name | Dr. Timothy Wade Hepner |
First Address | Tulsa, OK 74104-5472 |
Second Address | Tulsa, OK 74104-5472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 09/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020022913 | RAILROAD MEDICARE (01) | OK |
100131540A | (05) | OK |
F77936 | (02) | OK |