Individual
BARRY LUKE BOTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.R.S.S
Contact information
Practice address
100 RED MOON CIRCLE, CONCHO, OK 73022-7302
(405) 422-7452
Mailing address
100 RED MOON CIRCLE, CONCHO, OK 73022
(405) 422-7452
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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