Individual
COLIN STALLCUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
138 RIDGELINE DR, WEATHERFORD, OK 73096-9223
(405) 368-0532
Mailing address
138 RIDGELINE DR, WEATHERFORD, OK 73096-9223
(405) 368-0532
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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