Individual
GRANT DAVID NEUGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22758 S 494 RD, TAHLEQUAH, OK 74464-1631
(918) 772-0696
Mailing address
22758 S 494 RD, TAHLEQUAH, OK 74464-1631
(918) 772-0696
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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