Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 154 | OK |
N | 111NR0200X | Radiology | 154 | OK |
N | 213ER0200X | Radiology | 154 | OK |
N | 213ES0103X | Foot & Ankle Surgery | 154 | OK |
NPI | 1073511648 |
---|---|
Provider Name | Maureen Lee Crotty |
First Address | Tulsa, OK 74135-2227 |
Second Address | Tulsa, OK 74135-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 14/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100780270A | (05) | OK |
1720467483 | DME NPI (01) | OK |
T40739 | (02) |