Individual
SHADRICK BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8344 N 117TH EAST AVE, OWASSO, OK 74055-2136
(918) 841-3794
Mailing address
8344 N 117TH EAST AVE, OWASSO, OK 74055-2136
(918) 841-3794
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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