Individual
ANTHONY DIRTEATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3819
(918) 931-3700
Mailing address
113 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3819
(918) 931-3700
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/05/2024
Last updated
01/05/2024
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