Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 32144 | OK |
NPI | 1013278613 |
---|---|
Provider Name | Ronan Alexander Bakker |
First Address | Oklahoma City, OK 73126-8984 |
Second Address | Oklahoma City, OK 73120-8300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 10/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200690020A | (05) | OK |
836395 | MEDICARE (01) | OK |