Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3460 | OK |
NPI | 1003007378 |
---|---|
Provider Name | Glenn Alvin Foster JR. |
First Address | Norman, OK 73072 |
Second Address | Norman, OK 73072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 05/08/2007 |