Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25774 | OK |
Y | 111NI0900X | Internist | 25774 | OK |
N | 208000000X | Pediatrician | 25774 | OK |
NPI | 1003013723 |
---|---|
Provider Name | Justin Elliot Fields |
First Address | Tulsa, OK 74115-4957 |
Second Address | Norman, OK 73071-6400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 05/02/2016 |