Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 12474 | OK |
NPI | 1306841903 |
---|---|
Provider Name | Houshang Seradge |
First Address | Oklahoma City, OK 73126-0706 |
Second Address | Oklahoma City, OK 73109-3613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
990009843 | MEDICARE RAILROAD (01) | OK |
C95465 | (02) | OK |