Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 3150 | OK |
NPI | 1124312004 |
---|---|
Provider Name | Mrs. Jazmin Matlock Baker |
First Address | Tahlequah, OK 74464-4689 |
Second Address | Tahlequah, OK 74464-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 20/04/2016 |