Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R2622 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | R2622 | TX |
N | 207R00000X | Internist | BP10047202 | TX |
N | 111NI0900X | Internist | BP10047202 | TX |
NPI | 1003251943 |
---|---|
Provider Name | Jason Matthew Hirshburg |
First Address | Oklahoma City, OK 73104 |
Second Address | Oklahoma City, OK 73104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2013 |
Last Update Date | 04/01/2022 |