Individual
CHARLIE MAC RISENHOOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 NE 11TH ST, OKLAHOMA CITY, OK 73117-2605
(405) 230-1158
Mailing address
426 E EUFAULA ST, NORMAN, OK 73071-5806
(405) 675-1376
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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