Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 3838 | OK |
NPI | 1194710897 |
---|---|
Provider Name | Glen H. Bailey |
First Address | Oklahoma City, OK 73126-9024 |
Second Address | Norman, OK 73071-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75160 | (02) |