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Individual

JACOB OLIVER BUCHANAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4100 NW 155TH ST, EDMOND, OK 73013-9139
(512) 876-7942
Mailing address
4100 NW 155TH ST, EDMOND, OK 73013-9139
(512) 876-7942

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
10/15/2019
Last updated
10/15/2019
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