Individual
KRISTOPHER LEE BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
(580) 657-7299
Mailing address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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