Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 17603 | OK |
NPI | 1013913359 |
---|---|
Provider Name | Mr. Andrew Gottehrer |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74133-5801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100013710A | (05) | OK |
E78103 | (02) | OK |