Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 23866 | OK |
NPI | 1154302354 |
---|---|
Provider Name | Timothy J Nickel |
First Address | Tulsa, OK 74133-5702 |
Second Address | Tulsa, OK 74133-5702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 14/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H50918 | (02) | OK |