Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6405 | OK |
Y | 213EG0000X | General Practice | 6405 | OK |
NPI | 1003179847 |
---|---|
Provider Name | Reed Alexander Perryman |
First Address | Mcalester, OK 74501-5409 |
Second Address | Mcalester, OK 74501-5409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/06/2012 |