Individual
MR. MARSHALL THREADGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 SW TIMBER LANE LN, INDIAHOMA, OK 73552-2730
(580) 246-8301
Mailing address
14 SW TIMBER LANE LN, INDIAHOMA, OK 73552-2730
(580) 246-8301
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
450074
TX
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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