Individual
MATTHEW CLAY HEADRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3360
(918) 458-3511
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3360
(918) 458-3511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4027
OK
Other
Enumeration date
10/25/2006
Last updated
07/09/2007
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