Individual
DREW DETHEROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3080 W 3RD ST, ELK CITY, OK 73644-4323
(405) 424-7711
Mailing address
307 MOHAWK TRAIL, BURNS FLAT, OK 73624
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/16/2023
Last updated
02/16/2023
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