Organization
ETHERIDGE PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ROBERT ETHERIDGE BOCP LP (PROSTHETIST)
(405) 323-6936
Entity
Organization
Contact information
Practice address
2202 WESTPARK DR, SUITE A, NORMAN, OK 73069-4033
(405) 701-3733
(405) 701-3752
Mailing address
2202 WESTPARK DR, SUITE A, NORMAN, OK 73069-4033
(405) 701-3733
(405) 701-3752
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
C21410
OK
Other
Enumeration date
06/23/2015
Last updated
11/20/2015
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