Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1906 | OK |
N | 207Q00000X | Family Doctor | 1906 | OK |
NPI | 1215971734 |
---|---|
Provider Name | Harriet Huggard Shaw |
First Address | Tulsa, OK 74107-2705 |
Second Address | Tulsa, OK 74107-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 12/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100061850B | (05) | OK |
EO9631 | (02) | OK |