Individual
ANIETIE E OKON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 MARSHALL WAY, MARSHALL MEDICAL CENTER, PLACERVILLE, CA 95667
(530) 626-1166
(530) 626-3826
Mailing address
681 MAIN STREET, STE. 105, PLACERVILLE, CA 95667
(530) 626-1166
(530) 626-3826
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
A102633
CA
2085N0700X
Neuroradiology Physician
A102633
CA
2085N0904X
Nuclear Radiology Physician
A102633
CA
2085R0202X
Diagnostic Radiology Physician
36484
IA
2085R0202X
Diagnostic Radiology Physician
Primary
A102633
CA
2085R0203X
Therapeutic Radiology Physician
A102633
CA
2085R0204X
Vascular & Interventional Radiology Physician
A102633
CA
2085R0205X
Radiological Physics Physician
A102633
CA
2085U0001X
Diagnostic Ultrasound Physician
A102633
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47563
WELLMARK BCBS
IA
05
—
GR0053460
—
CA
Enumeration date
04/19/2007
Last updated
11/01/2012
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