Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3148 | OK |
NPI | 1043384357 |
---|---|
Provider Name | William M. Croom |
First Address | Oklahoma City, OK 73117-1214 |
Second Address | Oklahoma City, OK 73117-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 19/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T79921 | (02) | OK |