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Individual
ERIC W MIX
Active
Individual
ERIC W MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4316
OK
207Q00000X
Family Medicine Physician
Primary
4316
OK
Other
Enumeration date
10/24/2005
Last updated
08/31/2009
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