Individual
ZACKERY R DEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2017 W I 35 FRONTAGE RD STE 140, EDMOND, OK 73013-8555
(405) 757-3710
(405) 757-3711
Mailing address
2017 W I 35 FRONTAGE RD STE 140, EDMOND, OK 73013-8555
(405) 757-3710
(405) 757-3711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4394
OK
Other
Enumeration date
11/03/2020
Last updated
05/18/2022
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