Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 26830 | OK |
NPI | 1013983741 |
---|---|
Provider Name | Kevin Joseph Gancarczyk |
First Address | Tulsa, OK 74146-5830 |
Second Address | Tulsa, OK 74146-5830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200237950A | (05) | OK |