Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 21872 | OK |
Y | 207RH0002X | Hospice and Palliative Medicine | 21872 | OK |
NPI | 1285605113 |
---|---|
Provider Name | James M Ross |
First Address | Tulsa, OK 74104-4012 |
Second Address | Tulsa, OK 74104-4012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 03/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100148490A | (05) | OK |