Individual
JEREMIAH MATHEW COZBY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
27440 POTTS MTN RD, HEAVENER, OK 74937-3698
(918) 413-2678
Mailing address
27440 POTTS MTN RD, HEAVENER, OK 74937-3698
(918) 413-2678
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
GAAA-NYOA-BIMU
OK
Other
Enumeration date
04/07/2019
Last updated
04/07/2019
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