Individual
JAMES GLENN MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1824 S VAN BUREN ST, ENID, OK 73703-7903
(405) 230-1181
Mailing address
1201 W WALLACE DR, ENID, OK 73703-7912
(580) 231-8915
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1215150644
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V083161617
DRIVER ID
OK
Enumeration date
10/09/2020
Last updated
10/09/2020
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