Individual
JAMES IVERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6921 W GORE BLVD APT 601, LAWTON, OK 73505-5369
(580) 284-3770
Mailing address
PO BOX 7846, LAWTON, OK 73506-1846
(580) 280-3770
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4478
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L083091854
DRIVER'S LICENSE
OK
Enumeration date
05/21/2020
Last updated
05/21/2020
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