Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 8700 | OK |
NPI | 1003805425 |
---|---|
Provider Name | Stan Pelofsky |
First Address | Oklahoma City, OK 73120-9322 |
Second Address | Oklahoma City, OK 73120-9322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 27/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100012580A | (05) | OK |
C95347 | (02) |