Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 27920 | OK |
NPI | 1003040262 |
---|---|
Provider Name | Jacquelyn A O'banion |
First Address | Atlanta, GA 30322-1013 |
Second Address | Oklahoma City, OK 73104-5014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2009 |
Last Update Date | 13/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200306430B | (05) | OK |