Individual
RICKEY ALLEN THORNBURG JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
717 BUTLER ST, TAHLEQUAH, OK 74464-2400
(580) 399-6955
Mailing address
717 BUTLER ST, TAHLEQUAH, OK 74464-2400
(803) 996-6955
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/26/2023
Last updated
12/26/2023
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