Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 1110 | OK |
NPI | 1124049481 |
---|---|
Provider Name | Ms. Jumok K Bottoms |
First Address | Fort Sill, OK 73503-4473 |
Second Address | Ft Sill, OK 73503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 10/06/2021 |