Individual
DETRICK DEVON WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 1/2 2ND ST, SNYDER, OK 73566-1215
(580) 678-0847
Mailing address
PO BOX 224, SNYDER, OK 73566-0224
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
M082104066
OK
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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