Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5103 | OK |
NPI | 1003391699 |
---|---|
Provider Name | Gina Dillard |
First Address | Oklahoma City, OK 73102-1205 |
Second Address | Oklahoma City, OK 73102-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2018 |
Last Update Date | 28/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063823771 | VALIR PACE (01) |