Individual
TAZMEN A WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
Mailing address
5512 S DATE AVE, BROKEN ARROW, OK 74011-4854
(918) 984-5912
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558815936
—
OK
Enumeration date
09/18/2017
Last updated
09/18/2017
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