Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 22339 | WV |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 228320 | MA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 25575 | OK |
NPI | 1982721098 |
---|---|
Provider Name | Mr. Jose Antonio Sanclement |
First Address | Oklahoma City, OK 73104 |
Second Address | Oklahoma City, OK 73104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 05/05/2010 |