Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 13430 | OK |
Y | 207PE0004X | Emergency Medical Services | 13430 | OK |
NPI | 1003873209 |
---|---|
Provider Name | Mr. Dan D Donnell |
First Address | Edmond, OK 73013-7936 |
Second Address | Midwest City, OK 73110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 14/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100100920A | (05) | OK |
D38754 | (02) | OK |