Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 15626 | OK |
NPI | 1093785933 |
---|---|
Provider Name | Wayne N Leimbach |
First Address | Tulsa, OK 74133-5718 |
Second Address | Tulsa, OK 74104-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060007755 | MEDICARE RAILROAD (01) | OK |
100055940A | (05) | OK |
D42581 | (02) | OK |
OK400771 | MEDICARE PTAN (01) | OK |
P00611409 | MEDICARE RAILROAD (01) | OK |