Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | PT14297 | ND |
N | 207XS0117X | Orthopaedic Spine Surgeon | G87085 | CA |
NPI | 1043282957 |
---|---|
Provider Name | Sloane Roxanne Blair |
First Address | Lawton, OK 73502-0785 |
Second Address | Lawton, OK 73502-0785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 22/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G870850 | (05) | CA |
F71448 | (02) | CA |