Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 20098 | OK |
NPI | 1053418913 |
---|---|
Provider Name | Perry M. Santos |
First Address | Oklahoma City, OK 73112-4448 |
Second Address | Oklahoma City, OK 73112-4448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100214430B | (05) | OK |
F15579 | (02) |