Individual
BEN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
800 S TUCKER DR, TULSA, OK 74104-9700
(918) 631-5258
Mailing address
450 W 7TH ST, #1802, TULSA, OK 74119-1051
(918) 508-1175
(918) 631-3057
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
679
OK
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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