Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2842 | OK |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2842 | OK |
N | 207NS0135X | Procedural Dermatology | 2842 | OK |
NPI | 1205825619 |
---|---|
Provider Name | Edward Henry Yob |
First Address | Tulsa, OK 74133-7550 |
Second Address | Tulsa, OK 74133-7550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 16/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070015931 | RAILROAD MEDICARE (01) | OK |
100025020A | (05) | OK |
E72577 | (02) |