Individual
WILLIAM ROBERT ETHERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BOC LP
Contact information
Practice address
2202 WESTPARK DR, SUITE A, NORMAN, OK 73069-4032
(405) 701-3733
(405) 701-3752
Mailing address
2202 WESTPARK DR, SUITE A, NORMAN, OK 73069-4032
(405) 701-3733
(405) 701-3752
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
C21410
OK
Other
Enumeration date
04/14/2015
Last updated
06/23/2015
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