Individual
JOHN EDWIN SUNDERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
504 CONCORD LN, EDMOND, OK 73003-6127
(405) 514-1215
(405) 974-3805
Mailing address
504 CONCORD LN, EDMOND, OK 73003-6127
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
501
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501
—
OK
Enumeration date
07/29/2014
Last updated
07/29/2014
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