Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 14989 | OK |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 14989 | OK |
NPI | 1033187513 |
---|---|
Provider Name | Jesus E Medina |
First Address | Oklahoma City, OK 73117-1039 |
Second Address | Oklahoma City, OK 73104-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 20/04/2018 |