Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 9763 | OK |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 9763 | OK |
N | 207XS0117X | Orthopaedic Spine Surgeon | 9763 | OK |
NPI | 1235139379 |
---|---|
Provider Name | Mark A Capehart |
First Address | Tulsa, OK 74136-7816 |
Second Address | Tulsa, OK 74136-7816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D34474 | (02) | OK |