Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 19315 | OK |
NPI | 1083616247 |
---|---|
Provider Name | Stephen W Snell III |
First Address | Lawton, OK 73505-6121 |
Second Address | Lawton, OK 73505-9521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 04/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100074780A | (05) | OK |
G04747 | (02) | OK |