Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | H6533 | TX |
NPI | 1184618951 |
---|---|
Provider Name | Steven D Rea |
First Address | Norman, OK 73070-5718 |
Second Address | Midland, TX 79701-6407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23568 | (02) |