Basic Information
| Provider Information | |||||||||
| NPI: | 1124186820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFARO MARSHALL | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RADIOLOGY TECHNICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1334 N LANSING | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185872171 | ||||||||
| FaxNumber: | 9182956149 | ||||||||
| Practice Location | |||||||||
| Address1: | 1334 N LANSING | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185872171 | ||||||||
| FaxNumber: | 9182956149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 389242 | OK | Y | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
ID Information
| ID | Type | State | Issuer | Description | 37-1832 | 01 | OK | MEDICARE | OTHER | 389242 | 01 | OK | LICENSE NUMBER | OTHER | 37-1834 | 01 | OK | MEDICARE | OTHER | 37-1803 | 01 | OK | MEDICARE | OTHER |