Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 115 | OK |
NPI | 1013096494 |
---|---|
Provider Name | Mr. Ross Edwin Sethman |
First Address | Stillwater, OK 74074 |
Second Address | Stillwater, OK 74074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 08/07/2007 |