Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 34.004602 | OH |
Y | 207PE0004X | Emergency Medical Services | 3826 | OK |
NPI | 1013987288 |
---|---|
Provider Name | Steven L. Nussbaum |
First Address | Tulsa, OK 74137-7447 |
Second Address | Tulsa, OK 74137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100040600B | (05) | OK |
E00770 | (02) |