Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 17578 | OK |
NPI | 1164428215 |
---|---|
Provider Name | Mark Steven Hamra |
First Address | Tulsa, OK 74133-5593 |
Second Address | Broken Arrow, OK 74012-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49200 | (02) | OK |