Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 31595 | OK |
Y | 111NI0900X | Internist | 31595 | OK |
NPI | 1003203001 |
---|---|
Provider Name | Peter Madden |
First Address | Tulsa, OK 74114-4201 |
Second Address | Tulsa, OK 74135-2536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 07/05/2016 |