Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 26110 | IA |
NPI | 1073597175 |
---|---|
Provider Name | Joel David Stenzel |
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 | 01/12/2005 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0036798 | (05) | IA |
09366 | WELLMARK BCBS (01) | IA |
204730204 | (05) | MO |
F69950 | (02) |