Individual
ERIC W MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 ROCKEFELLER DR, MUSKOGEE, OK 74401-5075
(918) 781-9466
Mailing address
LOCKBOX #17, 2424 E. 21ST #100, TULSA, OK 74114-1711
(866) 321-8433
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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