Individual
DR. SUPHONG TECHATHUVANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
(918) 342-6610
Mailing address
9645 E CLOVER CREEK DR, CLAREMORE, OK 74017-1489
(918) 342-6200
(918) 342-6610
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
30243
NC
Other
Enumeration date
08/05/2006
Last updated
07/08/2007
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