Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2520 | OK |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2520 | OK |
NPI | 1588756951 |
---|---|
Provider Name | Ronald M. Eimen |
First Address | Tulsa, OK 74107-2726 |
Second Address | Mannford, OK 74044-0323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 13/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100129700A | (05) | OK |
857981 | MEDICARE (01) | OK |
E09845 | (02) |