Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1093209629 |
---|---|
Provider Name | Mr. Billy Joe James |
First Address | Oklahoma City, OK 73104-5007 |
Second Address | Oklahoma City, OK 73117-1045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |