Individual
JENNIE GAYLE SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8109 HIGHWAY 30, DURHAM, OK 73642-4256
(580) 799-7746
Mailing address
8109 HIGHWAY 30, DURHAM, OK 73642-4256
(580) 799-7746
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/19/2015
Last updated
02/19/2015
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