Individual
VU NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 CHOCTAW WAY, TALIHINA, OK 74571-2022
(918) 567-7000
(918) 567-7113
Mailing address
1 CHOCTAW WAY, TALIHINA, OK 74571-2022
(918) 567-7000
(918) 567-7113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5604
OK
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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