Individual
MARK HAYWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
44521 504TH AVE, TALIHINA, OK 74571-2064
(817) 235-2537
Mailing address
PO BOX 1273, TALIHINA, OK 74571-1273
(817) 235-2537
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305190B
—
OK
Enumeration date
12/12/2011
Last updated
12/12/2011
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