Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 11148 | OK |
NPI | 1023015443 |
---|---|
Provider Name | Mr. Chiu Shang Tsai |
First Address | Cordell, OK 73632-2009 |
Second Address | Cordell, OK 73632-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D42891 | (02) |