Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 24868 | OK |
NPI | 1043350275 |
---|---|
Provider Name | Jack L. Collier |
First Address | Oklahoma City, OK 73132-3385 |
Second Address | Oklahoma City, OK 73120-8382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200162400A | (05) | OK |