Individual
PHYLLIS DECARNELLE HANNAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
902 E LINCOLN RD, IDABEL, OK 74745-7337
(580) 286-2600
(580) 286-1087
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MO - 10627
MO
Other
Enumeration date
03/15/2006
Last updated
07/21/2022
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