Individual
MATTHEW SHANE DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PEER SPECIALIST
Contact information
Practice address
1006 BEAR LANE, OKMULGEE, OK 74447
(918) 549-2643
Mailing address
PO BOX 580, OKMULGEE, OK 74447-0580
(918) 549-2643
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/14/2024
Last updated
06/04/2025
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