Individual
BENJAMIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3080 W 3RD ST, ELK CITY, OK 73644-4323
(580) 303-9515
Mailing address
3080 W 3RD ST, ELK CITY, OK 73644-4323
(580) 303-9515
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
320310
OK
175T00000X
Peer Specialist
135850
OK
Other
Enumeration date
10/31/2024
Last updated
02/11/2025
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