Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 12693 | OK |
NPI | 1205836244 |
---|---|
Provider Name | T Jeffrey Emel |
First Address | Tulsa, OK 74137-4265 |
Second Address | Tulsa, OK 74136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 01/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100118540A | (05) | OK |
C94903 | (02) | OK |