Individual
BRIAN MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
HC 83 BOX 905, ANTLERS, OK 74523-9428
(580) 298-0200
Mailing address
PO BOX 686, ANTLERS, OK 74523-0686
(580) 298-0200
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/23/2007
Last updated
04/07/2009
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