Provider Demographics
NPI:1003319278
Name:EARLE OKI MD PROF CORP
Entity Type:Organization
Organization Name:EARLE OKI MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-829-0573
Mailing Address - Street 1:1500 E 2ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1196
Mailing Address - Country:US
Mailing Address - Phone:775-829-0573
Mailing Address - Fax:775-329-8528
Practice Address - Street 1:1500 E 2ND ST STE 203
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1196
Practice Address - Country:US
Practice Address - Phone:775-829-0573
Practice Address - Fax:775-329-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty