Individual
EDGAR JOHNSON HOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
8933 S 253RD EAST AVE, BROKEN ARROW, OK 74014-2299
(480) 529-3630
Mailing address
8933 S 253RD EAST AVE, BROKEN ARROW, OK 74014-2299
(480) 529-3630
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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