Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 4455 | OK |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 4455 | OK |
NPI | 1720102882 |
---|---|
Provider Name | Dr. William John Blum |
First Address | Norman, OK 73069-3946 |
Second Address | Norman, OK 73069-3946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/05/2019 |